Regionalization of care for obstetric hemorrhage and its effect on maternal mortality.

Abstract:

OBJECTIVE:To examine factors that influence the morbidity and mortality of peripartum hysterectomy and analyze the effect of hospital volume on maternal mortality. METHODS:We examined women who underwent peripartum hysterectomy at the time of cesarean delivery in a quality and resource utilization database. Procedure-associated intraoperative, perioperative, and postoperative medical complications, length of stay, intensive care unit use, and maternal mortality were analyzed. Hospitals were stratified into tertiles based on procedure volume and complications and compared using adjusted generalized estimating equations. Results are reported as odds ratios. RESULTS:Maternal mortality among the 2,209 women who underwent peripartum hysterectomy was 1.2%. After adjusting for other clinical and demographic factors, perioperative mortality was 71% (odds ratio 0.29, 95% confidence interval 0.10-0.88) lower in women who underwent operation at high-volume hospitals compared with those treated at low-volume facilities. Hospital volume had no effect on the rates of intraoperative injuries, medical complications, length of stay, or transfusion. In contrast, compared with women treated at low-volume centers, patients who underwent operation at high-volume hospitals had a lower incidence of perioperative surgical complications (odds ratio 0.66, 95% confidence interval 0.47-0.93) and a lower rate of intensive care unit usage (odds ratio 0.53, 95% confidence interval 0.34-0.83). CONCLUSION:Peripartum hysterectomy is associated with substantial morbidity and mortality. Maternal mortality is lower when the procedure is performed in high-volume hospital settings. LEVEL OF EVIDENCE:II.

journal_name

Obstet Gynecol

authors

Wright JD,Herzog TJ,Shah M,Bonanno C,Lewin SN,Cleary K,Simpson LL,Gaddipati S,Sun X,D'Alton ME,Devine P

doi

10.1097/AOG.0b013e3181df94e8

subject

Has Abstract

pub_date

2010-06-01 00:00:00

pages

1194-1200

issue

6

eissn

0029-7844

issn

1873-233X

pii

00006250-201006000-00015

journal_volume

115

pub_type

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