title: Up to seven-fold inter-hospital differences in obstetric anal sphincter injury rates- A birth register-based study in Finland.
abstract: BACKGROUND
  The occurrence of obstetric anal sphincter injuries (OASIS) - which may have serious, long-term effects on affected women, including faecal incontinence, despite primary repair - varies widely between countries and have been chosen one of the indicators for patient safety in Organisation for Economic Cooperation and Development (OECD) countries and in Nordic countries.
  
  
  RESULTS
  The aim of the study was to assess risks of OASIS among five university teaching hospitals and 14 non-university central hospitals with more than 1,000 deliveries annually during 1997-2007 in Finland. Women with singleton vaginal deliveries divided into two populations consisting of all 168,637 women from five university hospitals and all 255,660 women from non-university hospitals, respectively, derived from population-based register. Primiparous and multiparous women with OASIS (n = 2,448) were compared in terms of possible risk factors to primiparous and multiparous women without OASIS, respectively, using stepwise logistic regression analysis. The occurrences of OASIS varied from 0.7% to 2.1% in primiparous and from 0.1% to 0.3% in multiparous women among the university hospitals. Three-fold inter-hospital differences in OASIS rates did not significantly change after adjustment for patient mix or the use of interventions. In non-university hospitals OASIS rates varied from 0.2% to 1.4% in primiparous and from 0.02% to 0.4% in multiparous women, and the results remained virtually unchanged after adjustment for known risks.
  
  
  CONCLUSIONS
  Up to 3.2-fold inter-hospital differences in OASIS risk demonstrates significant differences in the quality of Finnish obstetric care.
authors.affiliation: Department of Nursing Science, University of Eastern Finland, P,O, Box 1627, 70211 Kuopio, Finland. shraisan@hytti.uku.fi.
authors.forename: Sari
authors.initials: S
authors.lastname: Räisänen
authors.forename: Katri
authors.initials: K
authors.lastname: Vehviläinen-Julkunen
authors.forename: Mika
authors.initials: M
authors.lastname: Gissler
authors.forename: Seppo
authors.initials: S
authors.lastname: Heinonen