INTRODUCTION: Rural hospital closures in the United States have left millions without access to healthcare. <50% of rural counties have hospital-based obstetrical services. Despite this, there are limited studies on the impact of obstetrical unit closures on patient outcomes. Augusta University Medical Center (AUMC) is the designated tertiary center for one of Georgia's six perinatal regions. We hypothesized that rural hospital closures directly impacted the outcomes of our patients. METHODS: The National Institute of Health's I2B2 software was used to identify charts of patients seen at AUMC for obstetrical services between January 1, 2010-December 31, 2011 and January 1, 2015-December 31, 2016. A retrospective chart review was performed to obtain and compare clinical outcomes between cohorts. RESULTS: 6,096 charts were reviewed. 58.6% (3572/6096) of charts met inclusion criteria representing 74.6% (1501/2012) and 71.2% (2071/2910) of actual deliveries at AUMC for 2010-11 and 2015-16, respectively. Evaluated parameters included: obesity, birthweight, prematurity, APGARs, length of stay, insurance, psychiatric disease, hypertension, NICU admission, neonatal death, ICU admission, readmission, tobacco/substance use, cardiopulmonary disease, diabetes, VTE, transfusion/return to operating room. There we statistically significant increases in PTD and low APGARs/birth weight for those >76 miles away. Statistically significant decreases in normal birthweight infants for those >76 miles away. There were increased rates of substance abuse for all zip codes in 2015-16. There were no statistically significant differences in obesity, hypertension, neonatal death, ICU admissions, readmissions, VTE, or transfusions/return to the OR. CONCLUSION: Hospital closures within our perinatal region directly impacted aspects of patient outcomes at AUMC.
OBJECTIVE: Currently, the assessment by journal reviewers of whether or not an article is likely to be highly cited in the future is entirely subjective. The objective of this study was to examine, in a high impact general obstetrics and gynecology journal, the association between characteristics of published papers in obstetrics and gynecology and the citation frequency in the first 5 years postpublication. STUDY DESIGN: This was a retrospective cohort study in which the baseline "cohort" was the population of articles published in the Green Journal (GJ) in 2012. The primary exposure was the subject category in which each article fell. We characterized every original research article based on subject (obstetrics, benign gynecology, oncology, reproductive endocrinology, urogynecology and family planning) and study design. We then used the Scopus database to determine the 5 year citation frequency. The 5 year citation frequency was our primary outcome. RESULTS: Among the 217 original research papers published by GJ in 2012, the number of obstetrics articles (121) exceeded gynecology articles (95) by 27.4%. In terms of the five-year citation frequency by subject category, the median number of citations was highest for family planning articles at 34.5, while benign gynecology articles had the lowest median number of citations at 16. Compared to benign gynecology articles, family planning articles had a five-year citation incidence rate that was more than twofold greater (IRR¼2.14, 95% CI 1.2-3.8, p¼0.008). There was no statistically significant difference in the five-year citation incidence rate between articles in the other subject categories as compared to benign gynecology articles. Within each subject category, there was no difference in the five-year citation frequency between control trials versus observational studies. Compared to gynecology papers, obstetrics research papers were much more likely to have an annual citation rate of 1 or less (OR¼3.15, 95% CI 1.22-8.15, p¼0.02). CONCLUSION: The cohort of original research papers the GJ published in 2012 were dominated by obstetrics articles. However, these articles were three times more likely than gynecology articles to have an annual citation rate of 1 or less. On the surface, this result suggests that journal editors should be cautious about accepting an excess of articles in one subject category as it may have a dilutional effect in terms of citations. Further studies are needed to corroborate our findings.
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