Anesthesia Provider Model, Hospital Resources, and Maternal Outcomes

Needleman, Jack; Minnick, Ann F.

doi:10.1111/j.1475-6773.2008.00919.x

Cited by 31 publications

(21 citation statements)

References 20 publications

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“…6 The delivery-related mortality rate in our study was 6.5 per 100,000 hospitalizations for delivery, comparable with rates recently reported elsewhere. 5,61 This ratio is less than half of the maternal mortality ratio, which includes all deaths during any point in pregnancy or within 42 days of the end of pregnancy, and substantially less than the pregnancy-related maternal mortality ratio, which includes all deaths during any point in pregnancy or up to a full year after the termination of pregnancy. 58 Severe obstetric morbidity includes a broader category of women who suffered major complications with delivery that were not necessarily associated with critical illness (e.g., blood transfusion).…”

Section: Discussionmentioning

confidence: 99%

Influence of Patient Comorbidities on the Risk of Near-miss Maternal Morbidity or Mortality

2011

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Background: Maternal morbidity and mortality are increased in the United States compared with that of other developed countries. The objective of this investigation is to determine the extent to which it is possible to predict which patients will experience near-miss morbidity or mortality. Methods:The authors defined near-miss morbidity as endorgan injury associated with length of stay greater than the 99 th percentile or discharge to a second medical facility, and identified all cases of near-miss morbidity or death from admissions for delivery in the 2003-2006 Nationwide Inpatient Sample. Logistic regression was used to examine the effect of maternal characteristics on rates of near-miss morbidity/mortality. Results: Approximately 1.3 per 1,000 hospitalizations for delivery was complicated by near-miss morbidity/mortality as defined in this study (95% CI 1.3-1.4). Most of these events (58.3%) occurred in 11.8% of the delivering population-in those women with important medical comorbidities or obstetric complications identified before admission for delivery. The highest rates were noted among women with pulmonary hypertension (98.0 cases per 1,000 deliveries), malignancy (23.4 per 1,000), and systemic lupus erythematosus (21.1 per 1,000).

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Section: Discussionmentioning

confidence: 99%

Influence of Patient Comorbidities on the Risk of Near-miss Maternal Morbidity or Mortality

2011

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“…These indexes have been applied in many studies in obstetrics for the purpose of describing and adjusting for comorbidity(10–19), despite having been developed for non-obstetric populations. The Charlson Comorbidity Index was developed to predict 1-year mortality in medical patients.…”

Section: Introductionmentioning

confidence: 99%

Development of a Comorbidity Index for Use in Obstetric Patients

Bateman

Mhyre

Hernández–Dı́az

et al. 2013

Obstetrics &Amp; Gynecology

366

337

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Objective To develop and validate a maternal comorbidity index to predict severe maternal morbidity, defined as the occurrence of acute maternal end-organ injury, or mortality. Methods Data were derived from the Medicaid Analytic eXtract for the years 2000 to 2007. The primary outcome was defined as the occurrence of maternal end-organ injury or death during the delivery hospitalization through 30 days postpartum. The dataset was randomly divided into a 2/3 development cohort and a 1/3 validation cohort. Using the development cohort, a logistic regression model predicting the primary outcome was created using a stepwise selection algorithm that included 24-candidate comorbid conditions and maternal age. Each of the conditions included in the final model was assigned a weight based on its beta coefficient, and these were used to calculate a maternal comorbidity index. Results The cohort included 854,823 completed pregnancies of which 9,901 (1.2%) were complicated by the primary study outcome. The derived score included 20 maternal conditions and maternal age. For each point increase in the score, the odds ratio for the primary outcome was 1.37, 95% Confidence Interval (CI) 1.35 to 1.39. The c-statistic for this model was 0.657, 95% CI 0.647 – 0.666. The derived score performed significantly better than available comorbidity indexes in predicting maternal morbidity and mortality. Conclusion This new maternal morbidity index provides a simple measure for summarizing the burden of maternal illness for use in the conduct of epidemiologic, health services, and comparative effectiveness research.

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“…Despite the authors' efforts to limit the effect of important biases in this work, our review of the paper leaves us with concerns surrounding the authors' conclusions. Having found no systematic differences in the rates of patient complications in hospitals employing different anesthesia provider models, Needleman and Minnick (2009) conclude that “these findings do suggest, that at least in the area of obstetrical anesthesia services, there may be no gain in anesthesia safety from restricting which licensed providers can provide these services.” The authors cite work by an author of the present commentary that emphasizes the need for caution in making clinical or health policy recommendations based on retrospective analyses of cross‐sectional data (Fleisher and Anderson 2002). In the present commentary, we discuss sources of bias that may remain in Needleman and Minnick's work due to the influence of unmeasured but potentially important clinical confounders.…”

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confidence: 95%

“…In the April 2009 issue of Health Services Research , Needleman and Minnick (2009) explore the relationship between anesthesia provider credentials and maternal outcomes. They pose questions with potentially significant implications for the delivery of obstetric care in the United States, where hospitals vary in the models they employ for the provision of anesthetic care for labor and delivery.…”

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confidence: 99%

Commentary: What Conclusions Can We Draw from Recent Analyses of Anesthesia Provider Model and Patient Outcomes?

Neuman

Schwartz

Fleisher

2010

Health Services Research

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Anesthesia Provider Model, Hospital Resources, and Maternal Outcomes

Abstract: Hospitals that use only CRNAs, or a combination of CRNAs and anesthesiologists, do not have systematically poorer maternal outcomes compared with hospitals using anesthesiologist-only models.

Cited by 31 publications

References 20 publications

Influence of Patient Comorbidities on the Risk of Near-miss Maternal Morbidity or Mortality

Influence of Patient Comorbidities on the Risk of Near-miss Maternal Morbidity or Mortality

Development of a Comorbidity Index for Use in Obstetric Patients

Commentary: What Conclusions Can We Draw from Recent Analyses of Anesthesia Provider Model and Patient Outcomes?

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