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Hospital variation in maternal complications following caesarean delivery in the United States: 2006–2012
Author(s) -
Moroz LA,
Wright JD,
Ananth CV,
Friedman AM
Publication year - 2016
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.13523
Subject(s) - complication , medicine , caesarean section , obstetrics , population , pregnancy , emergency medicine , pediatrics , surgery , genetics , environmental health , biology
Objective To assess hospital variability in and patient and hospital factors associated with caesarean delivery ( CD ) complications. Study Design Population‐based cohort. Setting United States delivery admissions. Population Women who underwent a CD between 2006 and 2012. Methods 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. Main outcome measure Composite complication rate. Results 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. Conclusions 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. Tweetable abstract A small number of hospitals demonstrate particularly high rates of caesarean complications.