1st Journal Reading

Presenter dr. Agustin Linda Astuti Moderator dr. H. Firmansyah Basir, SpOG (K)

INTRODUCTION
More than 4 million women give birth annually

in the US, which makes it the single most common reason for hospitalization Growth appreciation that the variation in hospital outcomes that have been observed in many medical and surgical diagnoses may also exist for childbirth

INTRODUCTION
The data of maternal childbirth outcomes are

minimum than clinical and surgical diagnoses for more 2 decades of research

INTRODUCTION
To examine the relationship between hospital

volume and maternal childbirth outcomes Specifically, the association between hospital childbirth volume and important maternal complications ( hemorrhage, infection, death, etc ) and whether it might differ for vaginal and cesarean deliveries

Materials & Methods

Prospective Observational Study

100% sample of State Inpatient Data (SID) For year 2006 from 11 states (Arizona, California, Florida, Iowa, Massachusetts, Maryland, North Carolina, New York, New Jersey, Washington, and Wisconsin)

Total sample 1, 683, 754 Childbirths in 1045 hospitals

PATIENTS INCLUDED IN THIS STUDY

Inclusion criteria

Spontaneous vaginal deliveries Cesarean deliveries Hemorrhage, Infection, Laceration, Thrombotic, Operative, Mortality, Composite

Exclusion criteria

Forceps and vacuum assisted deliveries

Study procedures
Demographic

characteristics (age, race, payor, comorbidities) of patients across hospital volume Evaluating the association between rates of childbirth complications and hospital obstetrics volume after adjusment for differences in patient demographics and comorbidity

Statistical analysis
Statistical analysis was performed by Bivariate methods

Results
1. Women who delivered in lower volume hospitals tended to younger, were more likely to be white, self pay, fewer comorbid . 2. Conversely, women who delivered in high volume hospitals were more likely to be older, Black, to have more comorbid illness 3. Results were similar for both of vaginal and cesarian deliveries

Results
4. Women who deliver at very low volume hospitals have higher complication rates, as do women who deliver at high volume hospitals

Table 1: Patient Characteristics by Annual Spontaneous Vaginal

Deliveries

PATIENT CHARACTERISTICS BY ANNUAL SPONTANEOUS VAGINAL DELIVERIES

(continued)

Table 2: PATIENT CHARACTERISTICS BY ANNUAL CESAREAN DELIVERIES

PATIENT CHARACTERISTICS BY ANNUAL CESAREAN DELIVERIES

(continued)

Table 3 : TOTAL POPULATION: UNADJUSTED PERCENT COMPLICATIONS BY HOSPITAL DECILE AND ROUTE OF DELIVERY

TOTAL POPULATION: UNADJUSTED PERCENT COMPLICATIONS BY HOSPITAL DECILE AND ROUTE OF DELIVERY (Continued)

Table 4: Unadjusted and djusted odds of composite adverse outcome by volume decile

UNADJUSTED AND ADJUSTED ODDS OF COMPOSITE ADVERSE OUTCOME BY VOLUME DECILE

(continued)

Comment
With such low volumes, it seems logical that

complication rates will be high, especially given the importance of both experience and teamwork in the health care setting
The higher rates of adverse outcomes in the highest

volume hospitals represent the higher risk of the population that our highest volume hospitals serve

CRITICAL APPRAISAL PROGNOSTIC

1. Are the representated sample have Yes the same condition regarding their disease?
2. Are sample followed up completely and prolonged ? No

3. Are result criteria got blinded?

Yes

4. If subgroup found with different prognosis, are they performed adjustment on important prognostic factors ?

Yes

5. Are there validation from independent group on sample?

6. Are result from this study important ? 7. How about result tendency on certain duration ? 8. How accurate prognostic prediction?

Yes

Yes, because it could be the prognostic of the patient No

P < 0,05

9. Could you applicate valid important prognostic evidence from your patient ?

Yes

10. Are patients on your study as same as patient at your clinical practice ?

Yes

11. Are important clinical evidence affect your Yes conclusion for advising or explaining on your patient ?