title: Rates of major obstetrical complications vary almost fivefold among US hospitals.
abstract: Of the approximately four million women who give birth each year in the United States, nearly 13 percent experience one or more major complications. But the extent to which the rates of major obstetrical complications vary across hospitals in the United States is unknown. We used multivariable logistic regression models to examine the variation in obstetrical complication outcomes across US hospitals among a large, nationally representative sample of more than 750,000 obstetrical deliveries in 2010. We found that 22.55 percent of patients delivering vaginally at low-performing hospitals experienced major complications, compared to 10.42 percent of similar patients delivering vaginally at high-performing hospitals. Hospitals were classified as having low, average, or high performance based on a calculation of the relative risk that a patient would experience a major complication. Patients undergoing a cesarean delivery at low-performing hospitals had nearly five times the rate of major complications that patients undergoing a cesarean delivery at high-performing hospitals had (20.93 percent compared to 4.37 percent). Our finding that the rate of major obstetrical complications varies markedly across US hospitals should prompt clinicians and policy makers to develop comprehensive quality metrics for obstetrical care and focus on improving obstetrical outcomes.
authors.affiliation: Laurent G. Glance (laurent_glance@urmc.rochester.edu) is vice chair for research and a professor of anesthesiology and public health sciences at the School of Medicine and Dentistry, University of Rochester, in New York.
authors.forename: Laurent G
authors.initials: LG
authors.lastname: Glance
authors.affiliation: Andrew W. Dick is a senior economist at the RAND Corporation in Boston, Massachusetts.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Dick
authors.affiliation: J. Christopher Glantz is a professor of obstetrics and gynecology at the School of Medicine and Dentistry, University of Rochester.
authors.forename: J Christopher
authors.initials: JC
authors.lastname: Glantz
authors.affiliation: Richard N. Wissler is a professor of anesthesiology at the School of Medicine and Dentistry, University of Rochester.
authors.forename: Richard N
authors.initials: RN
authors.lastname: Wissler
authors.affiliation: Feng Qian is an assistant professor of health policy and management, School of Public Health, University at Albany, in New York.
authors.forename: Feng
authors.initials: F
authors.lastname: Qian
authors.affiliation: Bridget M. Marroquin is an assistant professor of anesthesiology at the School of Medicine and Dentistry, University of Rochester.
authors.forename: Bridget M
authors.initials: BM
authors.lastname: Marroquin
authors.affiliation: Dana B. Mukamel is a professor in the Department of Medicine, University of California, Irvine.
authors.forename: Dana B
authors.initials: DB
authors.lastname: Mukamel
authors.affiliation: Arthur L. Kellermann is a professor in and dean of the F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, in Bethesda, Maryland.
authors.forename: Arthur L
authors.initials: AL
authors.lastname: Kellermann
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects / Q000706:statistics & numerical data; D016208:Databases, Factual; D036861:Delivery, Obstetric / Q000009:adverse effects* / Q000706:statistics & numerical data; D005260:Female; D006761:Hospitals / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D007744:Obstetric Labor Complications / Q000601:surgery*; D009774:Obstetrics / Q000592:standards; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy*; D011787:Quality of Health Care; D014481:United States
keywords: Hospitals; Maternal And Child Health; Quality Of Care; Variations