Hospital Volume, Provider Volume, and Complications After Childbirth in U.S. Hospitals

Abstract

III.

Practice and progress in obstetrics

“…On the basis of their definition of maternal complications, which included: haemorrhage, laceration, infection, and thrombotic complications, the authors found an adjusted complication rate of 15% in the first year following residency, which is within the range of what has been observed in previous large-scale studies using discharge data1 and a consistent downward trend in complications that was steepest in the first decade, but continued throughout the first three decades of practice. The trend was robust to a variety of different analytic techniques and subgroup analyses.…”

A multi-state analysis of postpartum readmissions in the United States

“…11,14 Relevant maternal comorbidities, pregnancy complications, deliveryrelated procedures, and intrapartum complications were identified using the diagnosis and procedure codes from the International Classification of Diseases, Ninth Revision (ICD-9), listed in Appendix A. Comorbidities and complications were classified using previously described algorithms for identifying reliable pregnancy-related data using ICD-9 codes. [15][16][17] Available maternal characteristics included for comparison were age, race/ethnicity, primary insurance payer, median household income (in quartiles based on a patient's postal code), and maternal comorbidities. Pregnancy characteristics included multiple gestation, prior cesarean delivery, presence of preterm labor, and placental previa (encompassing all abnormal placentations).…”

The impact of hospital obstetric volume on maternal outcomes in term, non–low-birthweight pregnancies

“…One prior study using the National Inpatient Sample found no consistent association between hospital obstetric volume and maternal complications. 9 In contrast, one study found increased rates of adverse maternal outcomes in very low-volume hospitals, and in the highest-volume hospitals for cesarean deliveries; 10 another study found increased rates of obstetric infection in teaching hospitals and hospitals with higher numbers of beds. 7 Several design and analysis differences could explain these differences: different study populations/states, modeling approaches, and outcome definitions.…”