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Serious maternal complications in relation to severe pre‐eclampsia: a retrospective cohort study of the impact of hospital volume
Author(s) -
Ananth CV,
Lavery JA,
Friedman AM,
Wapner RJ,
Wright JD
Publication year - 2017
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 - 10.1111/1471-0528.14384
Subject(s) - medicine , eclampsia , poisson regression , retrospective cohort study , obstetrics , confidence interval , relative risk , population , pediatrics , pregnancy , surgery , genetics , environmental health , biology
Objective We examined rates of serious maternal complications in relation to severe pre‐eclampsia based on the delivering hospital's annualised volume. Design Retrospective cohort study. Population and setting Singleton deliveries ( n = 25 782 235) in 439 hospitals in the USA . Methods Annualised hospital volume was categorised as 25–500, 501–1000, 1001–2000 and >2000. Main outcome measures Rates of in‐hospital maternal death and serious maternal complications, including puerperal cerebrovascular disorders, pulmonary oedema, disseminated intravascular coagulation, acute renal, heart and liver failure, sepsis, haemorrhage and intubation in relation to severe pre‐eclampsia. We derived adjusted risk ratio ( RR ) and 95% confidence interval ( CI ), from hierarchical Poisson regression models. Results Severe pre‐eclampsia was associated with an 8.7‐fold (95% CI 7.6, 10.1) risk of composite maternal complications, with similar RR s across levels of hospital volumes. However, compared with hospitals with low annual volume (<2000), maternal mortality rates in relation to severe pre‐eclampsia were lower in high volume hospitals. The rates of serious maternal complications were 410.7 per 10 000 to women who delivered in hospitals with a high rate of severe pre‐eclampsia (≥2.12%) and 584.8 per 10 000 to women who delivered in hospitals with low severe pre‐eclampsia rates (≤0.41; RR 1.75, 95% CI 1.24, 2.45). Conclusions While the risks of serious maternal complications in relation to severe pre‐eclampsia was similar across hospital delivery volume categories, deaths showed lower rates in large delivery volume hospitals than in smaller volume hospitals. The risk of complications was increased in hospitals with low compared with high severe pre‐eclampsia rates. Tweetable abstract Hospital volume had little impact on the association between severe pre‐eclampsia and maternal complications.