Provider volume and maternal complications after Caesarean section: results from a population-based study

Abstract

Background: A large literature search suggests a relationship between hospital/surgeon caseload volume and surgical complications. In this study, we describe associations between post-operative maternal complications following Caesarean section and provider caseload volume, provider years since graduation, and provider specialization, while adjusting for hospital volumes and patient characteristics. Methods: Our analysis is based on population-based discharge abstract data for the period of April 2004 to March 2014, linked to patient and physician universal coverage registry data. We consider all hospital admissions (N = 20,914) in New Brunswick, Canada, where a Caesarean Section surgery was recorded, as identified by a Canadian Classification of Health Intervention code of 5.MD.60.XX. We ran logistic regression models to identify the odds of occurrence of post-surgical complications during the hospital stay. Results: Roughly 2.6% of admissions had at least one of the following groups of complications: disseminated intravascular coagulation, postpartum sepsis, postpartum hemorrhage, and postpartum infection. The likelihood of complication was negatively associated with provider volume and provider years of experience, and positively associated with having a specialization other than maternal-fetal medicine or obstetrics and gynecology. Conclusions: Our results suggest that measures of physician training and experience are associated with the likelihood of Caesarean Section complications. In the context of a rural province deciding on the number of rural hospitals to keep open, this suggests a trade off between the benefits of increased volume versus the increased travel time for patients.

Using machine learning to identify quality-of-care predictors for emergency caesarean sections: a retrospective cohort study

“…Individual competency had little impact on AD in our statistical model across all ECS categories. This finding is somewhat surprising given that surgeons are thought to continuously improve their skills through repeated and deliberate practice 34–37. Our study focused exclusively on emergency CS.…”

“…This finding is somewhat surprising given that surgeons are thought to continuously improve their skills through repeated and deliberate practice. [34][35][36][37] Our study focused exclusively on emergency CS. Hence, the variability in the context and composition of teams may outweigh factors related to variations in individual skill levels.…”

Inflammation Indexes PLR, SII, AISI, MLR, and MCVL in Peripartum Treated Thrombophilia Peripartum Patients Undergoing Cesarean Section at Term

“…In postpartum treated thrombophilia patients, there was no significant difference between the postpartum inflammation indexes in patients who did not have their uterine cavity closed within the first 24-48 hours (PUUS≥1) compared to those who did manage to have their uterine cavity closed (PUUS=0). This is reasonable because, as discovered in [40], only a few patients had severe complications after cesarean section, and delays in closing the uterine cavity are not a complication.…”

Inflammation Indexes PLR, SII, AISI, MLR, NLPR and MCVL in Peripartum Treated Thrombophilia Patients Undergoing Cesarean Section at Term-STROBE Compliant

“…LWMH thromboprophylaxis was recommended only in women with highrisk thrombophilia or in women with low risk thrombophilia and previous venous thrombosis, as stated in the literature [54,55] In postpartum treated thrombophilia patients, there was no significant difference between the postpartum inflammation indexes in patients with uterine haematometra within the first 24-48 hours (PUUS≥1) compared to those without uterine haematometra (PUUS=0). This is reasonable because, as discovered in [56], only a few patients had severe complications after cesarean section, and delays in eliminating uterine haematometra are not a complication.…”