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Critical assessment of quality of care in obstetrics has been relatively slow compared with that in many medical fields. In other surgical specialties, low hospital and provider volume has been associated with poor health outcomes. Now, investigators analyzed data from a nationwide sample of 380,000 deliveries in 2007 to determine whether similar associations exist in obstetrics. Hospitals and providers were stratified into quartiles based on delivery volume; among providers, rates ranged from <7 (lowest volume) to ≥90 (highest volume) deliveries annually. Obstetric complications included severe perineal lacerations, postpartum hemorrhage, infections, and thromboses.
After adjustment for medical and pregnancy-related risk factors, complication rates were 50% higher in women delivered by lowest-volume providers than in those delivered by highest-volume providers (17.8% vs. 12.7%; P<0.001). The only significant relation between hospital volume and obstetric complications was higher risk for infection in higher-volume hospitals.
Janakiraman V et al. Hospital volume, provider volume, and complications after childbirth in U.S. hospitals. Obstet Gynecol 2011 Sep; 118:521.
Comment
Consistent with findings in some other surgical specialties, an inverse relation characterizes provider volume and rates of maternal obstetric complications. This study was limited in that providers were not characterized beyond annual volume, even though factors such as medical specialty and total years of clinical experience would be interesting to know. Although the results might be viewed as lending support to expanding the ranks of obstetric hospitalists or to public reporting of outcomes to improve quality, I agree with the authors that the best use of data such as these is to identify practitioners who need supplemental training and support.