The association between hospital obstetrical volume and maternal postpartum complications.
OBJECTIVE
The purpose of this study was to examine the relationship between delivery volume and maternal complications.


METHODS
We used administrative data to identify women who had been admitted for childbirth in 2006. Hospitals were stratified into deciles that were based on delivery volume. We compared composite complication rates across deciles.


RESULTS
We evaluated 1,683,754 childbirths in 1045 hospitals. Decile 1 and 2 hospitals had significantly higher rates of composite complications than decile 10 (11.8% and 10.1% vs 8.5%, respectively; P < .0001). Decile 9 and 10 hospitals had modestly higher composite complications as compared with decile 6 (8.8% and 8.5% vs 7.6%, respectively; P < .0001). Sixty percent of decile 1 and 2 hospitals were located within 25 miles of the nearest greater volume hospital.


CONCLUSIONS
Women who deliver at very low-volume hospitals have higher complication rates, as do women who deliver at exceedingly high-volume hospitals. Most women who deliver in extremely low-volume hospitals have a higher volume hospital located within 25 miles.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Iowa Hospital and Clinics, Iowa City, IA 52242, USA. kathy-kyser@uiowa.edu
Kathy L
KL
Kyser
Xin
X
Lu
Donna A
DA
Santillan
Mark K
MK
Santillan
Stephen K
SK
Hunter
Alison G
AG
Cahill
Peter
P
Cram
D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008428:Maternal Mortality; D007744:Obstetric Labor Complications / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D009775:Obstetrics and Gynecology Department, Hospital / Q000592:standards / Q000706:statistics & numerical data*; D061214:Patient Safety; D011247:Pregnancy; D019984:Quality Indicators, Health Care; D014481:United States