The Association Between Hospital Obstetrical Volume and Maternal Postpartum Complications

Abstract

Objective-To examine the relationship between delivery volume and maternal complications.Study Design-We used administrative data to identify women admitted for childbirth in 2006. Hospitals were stratified into deciles based upon delivery volume. We compared composite complication rates across deciles.Results-We evaluated 1,683,754 childbirths in 1045 hospitals. Deciles 1 and 2 hospitals had significantly higher rates of composite complications than Decile 10 (11.8%, 10.1%, vs. 8.5%, P < .0001). Deciles 9 and 10 hospitals had modestly higher composite complications as compared to Decile 6 (8.8%, 8.5%, vs 7.6%, P < .0001). Sixty percent of Decile 1 and 2 hospitals were located within 25 miles of the nearest greater volume hospital.Conclusions-Women delivering at very low volume hospitals have higher complication rates, as well as those delivering at exceeding high volume hospitals. Most women delivering in extremely low volume hospitals have a higher volume hospital located within 25 miles.

Surgical speed and risk for maternal operative morbidity in emergent repeat cesarean delivery

“…The overall rate of CD complications in the United States is generally reported to be <10%, based on nationwide hospitallevel data derived from billing codes. 11 Previous clinical studies have demonstrated that women who undergo a trial of labor after CD are at increased risk for adverse maternal outcomes compared with women who undergo repeat CD without a trial of labor. In addition to the rare but potentially catastrophic complication of uterine rupture, risks for transfusion and endometritis appear to be increased in this group.…”

Levels of maternal care

“…Maternal mortality is an uncommon event, and methods for tracking severe morbidity only have been proposed recently. 13 Data indicate that obstetric complications are significantly more frequent in hospitals with low delivery volume, 16 and that obstetric providers with the lowest patient volume have significantly increased rates of obstetric complications compared with highvolume providers. 17 Hospital clinical volume likely is a proxy measure for institutional and individual experience that may not be available at hospitals with lower volumes.…”

Safety of labour and delivery following closures of obstetric services in small community hospitals

“…Delivery at hospitals with low delivery volumes has been correlated with better, worse and comparable pregnancy outcomes compared with delivery at larger centres, [1][2][3][4][5][6][7] and studies examining the safety of delivery at rural versus urban hospitals have likewise produced conflicting results. [8][9][10][11][12] Establishing the relative safety of obstetric care in small rural hospitals is challenging.…”

“…[8][9][10][11][12] Establishing the relative safety of obstetric care in small rural hospitals is challenging. Studies comparing health outcomes according to hospital delivery volume [3][4][5] are influenced by underlying referral patterns in which higher rates of adverse outcomes at larger centres may reflect referrals of high-risk women. Adjustment for maternal risk factors is unlikely to completely account for case-mix differences.…”