TY - JOUR
T1 - Risk-adjusted operative delivery rates and maternal-neonatal outcomes as measures of quality assessment in obstetric care
T2 - A multicenter prospective study
AU - Maso, Gianpaolo
AU - Monasta, Lorenzo
AU - Piccoli, Monica
AU - Ronfani, Luca
AU - Montico, Marcella
AU - De Seta, Francesco
AU - Parolin, Sara
AU - Businelli, Caterina
AU - Travan, Laura
AU - Alberico, Salvatore
AU - Gigli, Carmine
AU - Domini, Daniele
AU - Fiscella, Claudio
AU - Casarsa, Sara
AU - Zompicchiatti, Carlo
AU - De Agostinis, Michela
AU - D'Atri, Attilio
AU - Mugittu, Raffaela
AU - Valle, Santo La
AU - Di Leonardo, Cristina
AU - Adamo, Valter
AU - Smiroldo, Silvia
AU - Del Frate, Giovanni
AU - Olivuzzi, Monica
AU - Giove, Silvio
AU - Parente, Maria
AU - Bassini, Daniele
AU - Melazzini, Simona
AU - Guaschino, Secondo
AU - Sartore, Andrea
AU - De Santo, Davide
AU - Demarini, Sergio
AU - Cont, Gabriele
AU - Marchesoni, Diego
AU - Rossi, Alberto
AU - Simon, Giorgio
AU - Tamburlini, Giorgio
PY - 2015/2/5
Y1 - 2015/2/5
N2 - 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.
AB - 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.
KW - Maternal outcome
KW - Neonatal outcome
KW - Operative delivery
KW - Quality of care
KW - Risk adjustment
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U2 - 10.1186/s12884-015-0450-2
DO - 10.1186/s12884-015-0450-2
M3 - Article
AN - SCOPUS:84924114455
VL - 15
JO - BMC Pregnancy and Childbirth
JF - BMC Pregnancy and Childbirth
SN - 1471-2393
IS - 1
M1 - 20
ER -