Risk-adjusted operative delivery rates and maternal-neonatal outcomes as measures of quality assessment in obstetric care: A multicenter prospective study

Gianpaolo Maso, Lorenzo Monasta, Monica Piccoli, Luca Ronfani, Marcella Montico, Francesco De Seta, Sara Parolin, Caterina Businelli, Laura Travan, Salvatore Alberico, Carmine Gigli, Daniele Domini, Claudio Fiscella, Sara Casarsa, Carlo Zompicchiatti, Michela De Agostinis, Attilio D'Atri, Raffaela Mugittu, Santo La Valle, Cristina Di LeonardoValter Adamo, Silvia Smiroldo, Giovanni Del Frate, Monica Olivuzzi, Silvio Giove, Maria Parente, Daniele Bassini, Simona Melazzini, Secondo Guaschino, Andrea Sartore, Davide De Santo, Sergio Demarini, Gabriele Cont, Diego Marchesoni, Alberto Rossi, Giorgio Simon, Giorgio Tamburlini

Research output: Contribution to journalArticle

Abstract

Background: Although the evaluation of caesarean delivery rates has been suggested as one of the most important indicators of quality in obstetrics, it has been criticized because of its controversial ability to capture maternal and neonatal outcomes. In an "ideal" process of labor and delivery auditing, both caesarean (CD) and assisted vaginal delivery (AVD) rates should be considered because both of them may be associated with an increased risk of complications. The aim of our study was to evaluate maternal and neonatal outcomes according to the outlier status for case-mix adjusted CD and AVD rates in the same obstetric population. Methods: Standardized data on 15,189 deliveries from 11 centers were prospectively collected. Multiple logistic regression was used to estimate the risk-adjusted probability of a woman in each center having an AVD or a CD. Centers were classified as "above", "below", or "within" the expected rates by considering the observed-to-expected rates and the 95% confidence interval around the ratio. Adjusted maternal and neonatal outcomes were compared among the three groupings. Results: Centers classified as "above" or "below" the expected CD rates had, in both cases, higher adjusted incidence of composite \ maternal (2.97%, 4.69%, 3.90% for "within", "above" and "below", respectively; p = 0.000) and neonatal complications (3.85%, 9.66%, 6.29% for "within", "above" and "below", respectively; p = 0.000) than centers "within" CD expected rates. Centers with AVD rates above and below the expected showed poorer and better composite maternal (3.96%, 4.61%, 2.97% for "within", "above" and "below", respectively; p = 0.000) and neonatal (6.52%, 9.77%, 3.52% for "within", "above" and "below", respectively; p = 0.000) outcomes respectively than centers with "within" AVD rates. Conclusions: Both risk-adjusted CD and AVD delivery rates should be considered to assess the level of obstetric care. In this context, both higher and lower-tha -expected rates of CD and "above" AVD rates are significantly associated with increased risk of complications, whereas the "below" status for AVD showed a "protective" effect on maternal and neonatal outcomes.

Original languageEnglish
Article number20
JournalBMC Pregnancy and Childbirth
Volume15
Issue number1
DOIs
Publication statusPublished - Feb 5 2015

Keywords

  • Maternal outcome
  • Neonatal outcome
  • Operative delivery
  • Quality of care
  • Risk adjustment

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

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    Maso, G., Monasta, L., Piccoli, M., Ronfani, L., Montico, M., De Seta, F., Parolin, S., Businelli, C., Travan, L., Alberico, S., Gigli, C., Domini, D., Fiscella, C., Casarsa, S., Zompicchiatti, C., De Agostinis, M., D'Atri, A., Mugittu, R., Valle, S. L., ... Tamburlini, G. (2015). Risk-adjusted operative delivery rates and maternal-neonatal outcomes as measures of quality assessment in obstetric care: A multicenter prospective study. BMC Pregnancy and Childbirth, 15(1), [20]. https://doi.org/10.1186/s12884-015-0450-2