title: Patterns of obstetric infection rates in a large sample of US hospitals.
abstract: OBJECTIVE
  Maternal infection is a common complication of childbirth, yet little is known about the extent to which infection rates vary among hospitals. We estimated hospital-level risk-adjusted maternal infection rates (RAIR) in a large sample of US hospitals and explored associations between RAIR and select hospital features.
  
  
  METHODS
  This retrospective cohort study included hospitals in the Perspective database with >100 deliveries over 2 years. Using a composite measure of infection, we estimated and compared RAIR across hospitals using hierarchical generalized linear models. We then estimated the amount of variation in RAIR attributable to hospital features.
  
  
  RESULTS
  Of the 1,001,189 deliveries at 355 hospitals, 4.1% were complicated by infection. Patients aged 15-19 years were 50% more likely to experience infection than those aged 25-29 years. Rupture of membranes >24 hours (odds ratio [OR], 3.0; 95% confidence interval [CI], 3.24-3.5), unengaged fetal head (OR, 3.11; 95% CI, 2.97-3.27), and blood loss anemia (OR, 2.42; 95% CI, 2.34-2.49) had the highest OR among comorbidities commonly found in patients with infection. RAIR ranged from 1.0-14.4% (median, 4.0%; interquartile range, 2.8-5.7%). Hospital features such as geographic region, teaching status, urban setting, and higher number of obstetric beds were associated with higher infection rates, accounting for 14.8% of the variation observed.
  
  
  CONCLUSIONS
  Obstetric RAIR vary among hospitals, suggesting an opportunity to improve obstetric quality of care. Hospital features such as region, number of obstetric beds, and teaching status account for only a small portion of the observed variation in infection rates.
authors: Department of Medicine, Baystate Medical Center, Springfield, MA, USA. Sarah.Goffmd@baystatehealth.org
authors: Sarah L
authors: SL
authors: Goff
authors: Penelope S
authors: PS
authors: Pekow
authors: Jill
authors: J
authors: Avrunin
authors: Tara
authors: T
authors: Lagu
authors: Glenn
authors: G
authors: Markenson
authors: Peter K
authors: PK
authors: Lindenauer
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006739:Hospital Administration; D006761:Hospitals / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D009775:Obstetrics and Gynecology Department, Hospital / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D018570:Risk Assessment; D014481:United States / Q000453:epidemiology; D055815:Young Adult
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