Obstetric Complication Rates Vary Widely Among US Hospitals

August 15, 2014

New research has found startling differences in complication rates for both vaginal and cesarean deliveries between low- and high-performing hospitals.

Of all US births, nearly 13% involve one or more obstetric complications. However, new research reveals that major obstetric complication rates vary widely among US hospitals, with more than 1 in 5 women experiencing a complication during a vaginal birth at the lowest performing hospitals.

Pertinent Points

- There are considerable differences in obstetric complication rates among the nation’s hospitals, with about 1 in 5 women experiencing a major complication while delivering at the lowest performing hospitals.

- To improve obstetric complication rates, best practices among the hospitals with the lowest complication rates must be identified.

A University of Rochester-led study, published in the August issue of Health Affairs, reports that complication rates vary as much as 5-fold among hospitals. While the authors analyzed data from 750,000 deliveries for the study, they noted the findings are preliminary because information about some risk factors was not included in the analysis.

Best practices among the hospitals with the lowest complication rates must be identified, the authors said in a call to develop a national quality reporting system to improve maternal outcomes.

"In the OB field, individual practice styles, training and anecdotal experience shape how we practice, but we didn't expect to see such wide differences in maternal outcomes, which is all we studied here," said Christopher Glantz, MD, MPH, an author on the paper. "For the most part, babies and the mothers do well, but we can do even better by studying the hospitals that perform well and following their best practices."

Hospitals were classified as having low, average, or high performance based on a calculation of the relative risk that a patient would experience a major complication. Of note, however, is that these complications, although important, generally are not life-threatening.

At low-performing hospitals, the authors found that 22.5% of patients delivering vaginally experienced major complications, compared with 10.4% of similar patients delivering at high-performing hospitals.

A similarly startling difference was also seen among women having a cesarean delivery. While nearly 21% of women experienced a major complication at low-performing hospitals, less than 5% of women delivering at the highest performing hospitals had a major complication.

Already efforts are under way to create a system for measuring and benchmarking data on maternal outcomes, with The American Congress of Obstetricians and Gynecologists and the American Society of Anesthesiologists taking the lead.