Obstetric Complication Rates Vary Widely Between Hospitals in U.S.

But figuring out what the best-performing centers are doing right can help everyone, researchers say

By Mary Elizabeth Dallas

Monday, August 4, 2014

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MONDAY, Aug. 4, 2014 (HealthDay News) -- An American woman's odds of encountering a complication during childbirth may depend on where she delivers, a new study suggests.

The study finds that about 13 percent of U.S. deliveries involve a complication, and obstetric complication rates vary widely among hospitals.

The researchers believe there's a key lesson to be learned from the research -- by taking cues from hospitals with the fewest complications, outcomes for all patients everywhere can be improved.

"There is significant variability in maternal outcomes across U.S. hospitals," study author Dr. Laurent Glance, health outcomes researcher at the University of Rochester, in Rochester, N.Y., said in a university news release.

In the study, published in the August issue of Health Affairs, Glance's team tracked outcomes from more than 750,000 deliveries across the United States.

They also calculated whether a hospital was low, average and high-performing, based on patients' relative risk for major complications.

The study found that complication rates during childbirth can vary up to five-fold between medical centers.

Women who had a cesarean delivery at low-performing hospitals experienced lacerations, bleeding, clots or infections at five times the rate of high-performing hospitals, the team found. These complications occurred at a rate of 21 percent at low-performing hospitals, compared to 4.4 percent at hospitals considered high-performing.

Meanwhile, women who delivered vaginally at low-performing hospitals were also twice as likely to have complications than those at high-performing hospitals.

"We didn't expect to see such wide differences in maternal outcomes, which is all we studied here," another study author, Dr. J. Christopher Glantz, a high-risk obstetrician at the University of Rochester, added in the news release.

Based on their findings, the study authors concluded that a national quality reporting system in the United States could become a powerful tool for improving childbirth outcomes across the country. The American Congress of Obstetricians and Gynecologists and the American Society of Anesthesiologists have a plan underway to create such a platform, the researchers noted.

"This presents us with an opportunity to identify 'best practices' at hospitals with low rates of maternal complications in order to improve outcomes for patients in all hospitals," Glance said.

The researchers noted however, that their findings are preliminary since they are based on administrative data and do not take into account key risk factors. They also pointed out that although it's important to consider childbirth complications, like lacerations and infections, these problems are rarely life-threatening.

SOURCE: University of Rochester Medical Center, news release, August 4, 2014.

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