Cesarean Delivery Outcomes for Rural FPs and Obstetricians
Cesarean Delivery Outcomes for Rural FPs and Obstetricians
The rural communities served by the 2 hospitals were similar in socioeconomic status (average income of $20,000 at both hospitals).Table 1 shows that the population characteristics of women at the 2 sites were similar in age, parity, and insurance status. Rates of Cesarean deliveries at the 2 hospitals also were similar, with 24% at the OBH and 22% at the FMH.
The average number of prenatal risk factors did not differ between the 2 hospitals. For most measures of prenatal risks, including gestational diabetes, smoking, multiple gestation, psychiatric disorder, and obesity, the study groups were similar (Table 2). Of note, the FMH had more patients with hypertension (14.4% FPH vs. 5.6% OBH; P = .02, Fisher exact test). Average gestational age at delivery was similar at both hospitals (39.2 weeks at the FMH, 39.1 weeks at the OBH; P = .6, t test). There was marked similarity in the indication for Cesarean delivery at the 2 hospitals (Table 3). In examining maternal outcomes, there were no maternal deaths and few intraoperative complications at either hospital, with no differences identified (Table 4).
While infectious complications (cellulitis, endometritis or endomyometritis, fever, wound infection, pneumonia, and sepsis) were uncommon, the rates were similar at each hospital. Table 4 shows that there were significantly fewer postoperative complications at the FMH (mean, 0.03 at the FMH vs. 0.12 at the OBH; P = .03). The specific complications are listed in Table 4. Length of stay for mothers following Cesarean delivery was longer at the FMH compared with the OBH (3.0 vs. 2.6 days; P < .01).
Neonatal outcomes were similar at both hospitals (Table 5). There were no differences in preterm deliveries (<37 weeks' gestation) between hospitals (6.2% at the FPH vs. 7.8% at the OBH; P = .4). One fetal death at 38 weeks occurred at the FMH because of amniotic band syndrome with a cord accident.
Data on the surgical process of care is provided in Table 6. While neither hospital met the ACOG goal of ≤30 minutes between the decision to operate and incision, there was a trend toward shorter decision to incision time at the FMH (44 vs. 55.1 minutes; P = .08). Length of the surgery was shorter at the OBH (42 minutes) compared with the FMH (55 minutes) (P < .01). Another frequently used quality measure is that scheduled Cesarean deliveries should not occur before 39.0 weeks. On this measure the 2 hospitals were very similar as well.
Results
The rural communities served by the 2 hospitals were similar in socioeconomic status (average income of $20,000 at both hospitals).Table 1 shows that the population characteristics of women at the 2 sites were similar in age, parity, and insurance status. Rates of Cesarean deliveries at the 2 hospitals also were similar, with 24% at the OBH and 22% at the FMH.
The average number of prenatal risk factors did not differ between the 2 hospitals. For most measures of prenatal risks, including gestational diabetes, smoking, multiple gestation, psychiatric disorder, and obesity, the study groups were similar (Table 2). Of note, the FMH had more patients with hypertension (14.4% FPH vs. 5.6% OBH; P = .02, Fisher exact test). Average gestational age at delivery was similar at both hospitals (39.2 weeks at the FMH, 39.1 weeks at the OBH; P = .6, t test). There was marked similarity in the indication for Cesarean delivery at the 2 hospitals (Table 3). In examining maternal outcomes, there were no maternal deaths and few intraoperative complications at either hospital, with no differences identified (Table 4).
While infectious complications (cellulitis, endometritis or endomyometritis, fever, wound infection, pneumonia, and sepsis) were uncommon, the rates were similar at each hospital. Table 4 shows that there were significantly fewer postoperative complications at the FMH (mean, 0.03 at the FMH vs. 0.12 at the OBH; P = .03). The specific complications are listed in Table 4. Length of stay for mothers following Cesarean delivery was longer at the FMH compared with the OBH (3.0 vs. 2.6 days; P < .01).
Neonatal outcomes were similar at both hospitals (Table 5). There were no differences in preterm deliveries (<37 weeks' gestation) between hospitals (6.2% at the FPH vs. 7.8% at the OBH; P = .4). One fetal death at 38 weeks occurred at the FMH because of amniotic band syndrome with a cord accident.
Data on the surgical process of care is provided in Table 6. While neither hospital met the ACOG goal of ≤30 minutes between the decision to operate and incision, there was a trend toward shorter decision to incision time at the FMH (44 vs. 55.1 minutes; P = .08). Length of the surgery was shorter at the OBH (42 minutes) compared with the FMH (55 minutes) (P < .01). Another frequently used quality measure is that scheduled Cesarean deliveries should not occur before 39.0 weeks. On this measure the 2 hospitals were very similar as well.
Source...