Provider volume related to childbirth complication rate

August 25, 2011

"Women whose babies are delivered by a provider who performs few deliveries are more likely to suffer childbirth complications than women whose providers have a higher volume of deliveries, according to a new study published in Obstetrics and Gynecology (2011;118[3]:521-527). MORE "

Women whose babies are delivered by a provider who performs few deliveries are more likely to suffer childbirth complications than women whose providers have a higher volume of deliveries, according to a new study published in Obstetrics and Gynecology (2011;118[3]:521-527).

The nationwide retrospective cohort study examined the relationship between provider delivery volume, hospital volume, and the odds of 4 categories of maternal complications: lacerations, hemorrhage, infections, and thromboses.

Researchers analyzed data from the 2007 National Inpatient Sample of the Healthcare Cost and Utilization Project on 1,365 hospitals with volumes ranging from 10 to 13,890 deliveries per year and 6,963 providers with volumes ranging from 1 to 1,731 deliveries per year. They found no consistent relationship between hospital volume and maternal complications but discovered a significant association between complications and individual provider volume. Women attended by providers in the lowest quartile of provider volume (ie, fewer than 7 deliveries per year) had 50% greater odds of complications and a 5% higher adjusted rate than women cared for by providers in the highest quartile (ie, 90 or more deliveries).

The data show that “if in fact there is a causal link between volume and outcomes, there is 1 extra complication for every 20 women who receive care with a low-volume provider compared with a high-volume provider,” the researchers observe. Each of the 4 complications occurred more often among the lowest-volume providers than among higher-volume providers. Adjusting for hospital characteristics and cesarean delivery rate affected results only modestly.

The authors suggest that hospitals or specialty groups might take steps to ensure that providers perform a minimum number of deliveries or take part in simulation exercises. Low-volume providers deliver babies for 24,000 women in the United States every year.

Read other articles in this issue of Special Delivery.