Rates Of Major Obstetrical Complications Vary Almost Fivefold Among US Hospitals

Glance, Laurent G.; Dick, Andrew W.; Glantz, J. Christopher; Wissler, Richard N.; Qian, Feng; Marroquin, Bridget M.; Mukamel, Dana B.; Kellermann, Arthur L.

doi:10.1377/hlthaff.2013.1359

Cited by 53 publications

(44 citation statements)

References 37 publications

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“…Previous research has shown that implementing maternal safety bundles for obstetric hemorrhage can effectively reduce severe maternal morbidity. 34 Further research is needed to validate our findings. We found two institutional characteristics associated with hospital performance in combined maternal and newborn outcomes-type of ownership and delivery volume.…”

Section: F I G U R Ementioning

confidence: 76%

Optimal maternal and neonatal outcomes and associated hospital characteristics

Campbell

Illuzzi

Lee

et al. 2018

Birth

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Background: This study aims to examine hospital variation in both maternal and neonatal morbidities and identify institutional characteristics associated with hospital performance in a combined measure of maternal and neonatal outcomes. Methods: Using the California Linked Birth File containing data from birth certificate and hospital discharge records, we identified 1 322 713 term births delivered at 248 hospitals during 2010-2012. For each hospital, a risk-standardized rate of severe maternal morbidities and a risk-standardized rate of severe newborn morbidities were calculated after adjusting for patient clinical risk factors. Hospitals were ranked based on combined information on their maternal and newborn morbidity rates. Results: Risk-standardized severe maternal and severe newborn morbidity rates varied substantially across hospitals (10th to 90th percentile range = 67.5-148.2 and 141.8-508.0 per 10 000 term births, respectively), although there was no significant association between the two (P = 0.15). Government hospitals (non-Federal) were more likely than other hospitals to be in worse rank quartiles (P value for trend = 0.004), whereas larger volume was associated with better rank among hospitals in the first three quartiles (P = 0.004). The most prevalent morbidities that differed progressively across hospital rank quartiles were severe hemorrhage, disseminated intravascular coagulation, and heart failure during procedure/surgery for mothers, and severe infection, respiratory complication, and shock/resuscitation for neonates. Conclusions: Hospitals with low maternal morbidity rates may not have low neonatal morbidity rates and vice versa, highlighting the importance of assessing joint maternal-newborn outcomes in order to fully characterize a hospital's obstetrical performance. Hospitals with smaller volume and government ownership tend to have less desirable outcomes and warrant additional attention in future quality improvement efforts. K E Y W O R D Schildbirth, hospital variation, morbidity, obstetric, quality and safety 290 | CAMPBELL Et AL.

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Section: F I G U R Ementioning

confidence: 76%

Optimal maternal and neonatal outcomes and associated hospital characteristics

Campbell

Illuzzi

Lee

et al. 2018

Birth

View full text Add to dashboard Cite

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“…Consistent with prior studies on quality of maternity care, 2, 17 we chose three broad categories of maternal complications. Individual adverse outcomes are rare in obstetrics, so we chose broad categories to enable sufficient number of events and statistical power.…”

Section: Methodsmentioning

confidence: 99%

“…1 Recent studies have documented wide variation in hospital-level rates of obstetric procedures and complications 23 and alarming differences in complication rates between weekdays and weekends in obstetric units, 4 but the drivers of this variation remain incompletely characterised. In recent years, large studies have found null associations between obstetric processes of care and quality metrics, 5 and between recently adopted quality measures (ie, elective early-term delivery) and perinatal morbidity.…”

Section: Introductionmentioning

confidence: 99%

A ‘busy day’ effect on perinatal complications of delivery on weekends: a retrospective cohort study

et al. 2016

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Objective To evaluate whether busy days on a labour and delivery unit are associated with maternal and neonatal complications of childbirth in California hospitals, accounting for weekday/weekend births. Design This is a population-based retrospective cohort study. Setting Linked vital statistics/patient discharge data for California births between 2009 and 2010 from the Office of Statewide Health Planning and Development. Participants All singleton, cephalic, non-anomalous California births between 2009 and 2010 (N=724 967). Main outcomes The key exposure was high daily obstetric volume, defined as giving birth on a day when the number of births exceeded the hospital-specific 75th percentile of daily delivery volume. Outcomes were a range of maternal and neonatal complications. Results Several maternal and neonatal complications were increased on high-volume days and weekends following adjustment for maternal demographics, annual hospital birth volume and teaching hospital status. For example, compared with low-volume weekdays, the odds of Apgar <7 on low-volume weekend days and high-volume weekend days were 11% (adjusted OR (aOR) 1.11, CI 1.03 to 1.21) and 29% higher (aOR 1.29, CI 1.10 to 1.52), respectively. High volume was associated with increased odds of neonatal seizures on weekdays (aOR 1.33, CI 1.01 to 1.71) and haemorrhage on weekends (aOR 1.11, CI 1.01 to 1.22). After accounting for between-hospital variation, weekend delivery remained significantly associated with increased odds of Apgar score <7, neonatal intensive care unit admission, prolonged maternal length of stay and the odds of neonatal seizures remained increased on high-volume weekdays. Conclusions Our findings suggest that weekend delivery is a consistent risk factor for a range of perinatal complications and there may be variability in how well hospitals handle surges in volume.

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“…It is important to evaluate whether differences in outcomes exist between hospitals with different professional models because increasing evidence suggests that rates of obstetric interventions vary widely across hospitals and are not explained by patient risk factors. 5,6 …”

Section: Introductionmentioning

confidence: 99%

Midwifery presence in United States medical centers and labor care and birth outcomes among low‐risk nulliparous women: A Consortium on Safe Labor study

Neal

Carlson

Phillippi

et al. 2018

Birth

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Background: The presence of midwives in a health system may affect perinatal outcomes but has been inadequately described in United States settings. Our objective was to compare labor processes and outcomes for low-risk nulliparous women birthing in United States medical centers with interprofessional care (midwives and physicians) versus noninterprofessional care (physicians only). Methods: We conducted a retrospective cohort study using Consortium on Safe Labor data from low-risk nulliparous women who birthed in interprofessional (n = 7393) or noninterprofessional centers (n = 6982). Unadjusted, adjusted (age, race, health insurance type), propensity-adjusted, and propensity-matched logistic regression models were used to compare outcomes. Results: There was concordance across logistic regression models, the most restrictive and conservative of which were propensity-matched models. With this approach, women at interprofessional medical centers, compared with women at noninterprofessional centers, were 74% less likely to undergo labor induction (risk ratio [RR] 0.26; 95% CI 0.24–0.29) and 75% less likely to have oxytocin augmentation (RR 0.25; 95% CI 0.22–0.29). The cesarean birth rate was 12% lower at interprofessional centers (RR 0.88; 95% CI 0.79–0.98). Adverse neonatal outcomes occurred in only 0.3% of births and were thus too rare to be modeled. Conclusions: The care processes and birth outcomes at interprofessional and noninterprofessional medical centers differed significantly. Nulliparous women receiving care at interprofessional centers were less likely to experience induction, oxytocin augmentation, and cesarean than women at noninterprofessional centers. Labor care and birth outcome differences between interprofessional and noninterprofessional centers may be the result of the presence of midwives and interprofessional collaboration, organizational culture, or both.

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Rates Of Major Obstetrical Complications Vary Almost Fivefold Among US Hospitals

Cited by 53 publications

References 37 publications

Optimal maternal and neonatal outcomes and associated hospital characteristics

Optimal maternal and neonatal outcomes and associated hospital characteristics

A ‘busy day’ effect on perinatal complications of delivery on weekends: a retrospective cohort study

Midwifery presence in United States medical centers and labor care and birth outcomes among low‐risk nulliparous women: A Consortium on Safe Labor study

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