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Patterns of obstetric infection rates in a large sample of US hospitals
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  • Sarah Goff, MD, Baystate Health
  • Penny Pekow, Baystate Health
  • Jill Avrunin, Baystate Health
  • Tara Lagu, MD, Baystate Health
  • Glenn Markenson, MD, Baystate Health
  • Peter Lindenauer, MD, Baystate Health
Document Type
Article, Peer-reviewed
Publication Date
6-1-2013
Abstract
OBJECTIVE: Maternal infection is a common complication of childbirth, yet little is known about the extent to which infection rates vary among hospitals. We estimated hospital-level risk-adjusted maternal infection rates (RAIR) in a large sample of US hospitals and explored associations between RAIR and select hospital features. STUDY DESIGN: This retrospective cohort study included hospitals in the Perspective database with >100 deliveries over 2 years. Using a composite measure of infection, we estimated and compared RAIR across hospitals using hierarchical generalized linear models. We then estimated the amount of variation in RAIR attributable to hospital features. RESULTS: Of the 1,001,189 deliveries at 355 hospitals, 4.1% were complicated by infection. Patients aged 15-19 years were 50% more likely to experience infection than those aged 25-29 years. Rupture of membranes >24 hours (odds ratio [OR], 3.0; 95% confidence interval [CI], 3.24-3.5), unengaged fetal head (OR, 3.11; 95% CI, 2.97-3.27), and blood loss anemia (OR, 2.42; 95% CI, 2.34-2.49) had the highest OR among comorbidities commonly found in patients with infection. RAIR ranged from 1.0-14.4% (median, 4.0%; interquartile range, 2.8-5.7%). Hospital features such as geographic region, teaching status, urban setting, and higher number of obstetric beds were associated with higher infection rates, accounting for 14.8% of the variation observed. CONCLUSION: Obstetric RAIR vary among hospitals, suggesting an opportunity to improve obstetric quality of care. Hospital features such as region, number of obstetric beds, and teaching status account for only a small portion of the observed variation in infection rates.
Citation Information
Goff SL, Pekow PS, Avrunin J, Lagu T, Markenson G, Lindenauer PK. Patterns of obstetric infection rates in a large sample of US hospitals. Am J Obstet Gynecol. 2013 Jun;208(6):456.e1-456.e13.