Hospital delivery volume, severe obstetrical morbidity, and failure to rescue

Abstract

Background In the setting of persistently high risk for maternal mortality and severe obstetric morbidity, little is known about the relationship between hospital delivery volume and maternal outcomes. Objective The objectives of this analysis were (i) to determine maternal risk for severe morbidity during delivery hospitalizations by hospital delivery volume in the United States; and (ii) to characterize, by hospital volume, the risk for mortality in the setting of severe obstetrical morbidity – a concept known as failure to rescue. Study Design This cohort study evaluated 50,433,539 delivery hospitalizations across the United States from 1998 to 2010. The main outcome measures were (i) severe morbidity defined as a composite of any one of fifteen diagnoses representative of acute organ injury and critical illness, and (ii) failure to rescue, defined as death in the setting of severe morbidity. Results The prevalence of severe morbidity rose from 471.2 to 751.5 cases per 100,000 deliveries from 1998 to 2010, an increase of 59.5%. Failure to rescue was highest in 1998 (1.5%), decreased to 0.6% in 2007, and rose to 0.9% in 2010. In models adjusted for comorbid risk and hospital factors, both low and high annualized delivery volume were associated with increased risk for failure to rescue and severe morbidity. However, the relative importance of hospital volume for both outcomes compared to other factors was relatively small. Conclusions While low and high delivery volume are associated with increased risk for both failure to rescue and severe maternal morbidity, other factors, in particular characteristics of individual centers, may be more important in determining outcomes.

Improving hospital quality to reduce disparities in severe maternal morbidity and mortality

“…28 Using the National Inpatient Survey, Friedman et al found differences in severe maternal morbidity and deaths associated with severe maternal morbidity in both low and high volume hospitals. 29 However, hospital volume explained only a small proportion of the overall hospital-level variation. A study on the same dataset documented increasing risks of severe maternal morbidity over time in hospitals with less than 1000 deliveries a year.…”

Neue Volume-Outcome-Ergebnisse in der Perinatalmedizin

“…Von insgesamt 6.464 Treffern der Literaturrecherche wurden nach einem mehrstufigen Auswahlprozess schließlich 11 relevante Artikel zur Forschungsfrage identifiziert und analysiert. Die eingeschlossenen Studien stammen aus Finnland (Karalis et al 2016;Pyykönen et al 2014;Hemminki et al 2011) den USA (Friedman et al 2016;Snowden et al 2012), Deutschland (Heller et al 2002;Heller et al 2003), Australien (Tracy et al 2006), Norwegen (Moster et al 2001), Großbritannien (Joyce et al 2004) und Schweden (Finnström et al 2006). Die Daten sind zumeist nationalen Geburtsregistern entnommen.…”

“…Da die Publikationen unterschiedliche Ergebnisse berichten, werden sie im Folgenden dennoch separat betrachtet. Eine der beiden Studien aus den USA nutzte Daten einer Institution für Forschung und Qualität im Gesundheitssektor (Friedman et al 2016). Die Studien der nordischen Länder und die australische Studie beziehen jeweils landesweite Daten der nationalen Geburtsregister ein, mit Selektierungen bezüglich des Ausschlusses von Mehrlingsgeburten (Finnström et al 2006), Risikogeburten (Karalis et al 2016) und nicht termingerechten Geburten bzw.…”

“…Eine kalifornische Studie untersuchte die maternalen Outcomes Geburtskomplikationen und Müttersterblichkeit (Friedman et al 2016…”

The effect of maternal health conditions on maternal morbidity in women with a prior cesarean: the role of elective repeat cesarean delivery

“…The potential bias can be assessed by comparing the modified NIEs to the original NIEs, since the unmediated TEs obtained from the models of exposure on outcome are not confounded. [44] 3. RESULTS…”