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- Title
Hospital variation in maternal complications following caesarean delivery in the United States: 2006-2012.
- Authors
Moroz, LA; Wright, JD; Ananth, CV; Friedman, AM
- Abstract
<bold>Objective: </bold>To assess hospital variability in and patient and hospital factors associated with caesarean delivery (CD) complications.<bold>Study Design: </bold>Population-based cohort.<bold>Setting: </bold>United States delivery admissions.<bold>Population: </bold>Women who underwent a CD between 2006 and 2012.<bold>Methods: </bold>Hospital-specific random-effects log-linear regression models were developed to account for patient, obstetric, and hospital risk factors related to a composite complication outcome including infection, haemorrhage, surgical complications and prolonged hospital stay. Between-hospital variability in rates of CD complications was also estimated.<bold>Main Outcome Measure: </bold>Composite complication rate.<bold>Results: </bold>Among 1 339 397 women who underwent CD in 457 hospitals, 6.4% (n = 85 838) experienced a complication. The most frequent complications were haemorrhage, transfusion, length of stay >7 days, and endometritis. Complications were strongly associated with the presence of obstetric factors and pre-existing medical conditions. Complication rates were 54% higher among black (8.8%) than white (5.7%) women (P < 0.001), and were more common in teaching (8.1%) than non-teaching (5.4%) hospitals (P < 0.001). In an adjusted model, the mean complication rate was 6.7%. A small proportion of hospitals (4.8%) had a complication rate greater than twice the mean (≥13.4%). Complications were strongly associated with the presence of obstetrical factors and pre-existing medical conditions.<bold>Conclusions: </bold>CD complication rates are strongly associated with patient and obstetric factors. While CD complication rates may be a quality metric of limited utility given the low rate of complications across most hospitals, a small number of hospitals demonstrate particularly high rates of complications. Review of CD complication rates may be an important aspect of quality assurance processes for these centres.<bold>Tweetable Abstract: </bold>A small number of hospitals demonstrate particularly high rates of caesarean complications.
- Subjects
UNITED States; CESAREAN section complications; PREGNANCY complications; OBSTETRICS; LENGTH of stay in hospitals; MEDICAL quality control; BLOOD transfusion; CESAREAN section; ENDOMETRIAL diseases; HEMORRHAGE; SURGICAL complications; SPECIALTY hospitals
- Publication
BJOG: An International Journal of Obstetrics & Gynaecology, 2016, Vol 123, Issue 7, p1115
- ISSN
1470-0328
- Publication type
journal article
- DOI
10.1111/1471-0528.13523