4.6 Article

The association between hospital obstetric volume and perinatal outcomes in California

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Publisher

MOSBY-ELSEVIER
DOI: 10.1016/j.ajog.2012.09.029

Keywords

asphyxia; health care systems; health facility size; neonatal mortality

Funding

  1. University of California, San Francisco Women's Reproductive Health Research Career Development Award, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health [K12 HD001262]

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OBJECTIVE: We sought to analyze the association between hospital obstetric volume and perinatal outcomes in California. STUDY DESIGN: This was a retrospective cohort study of births occurring in California in 2006. Hospitals were divided into 4 obstetric volume categories. Unadjusted rates of neonatal mortality and birth asphyxia were calculated for each category, overall and among term deliveries with birthweight > 2500 g. Multivariable logistic regression was used to control for confounders. Deliveries in rural hospitals were analyzed separately using different volume categories. RESULTS: Prevalence of asphyxia increased with decreasing hospital volume overall and among term, non-low-birthweight infants, from 9/10,000 live births at highest-volume hospitals to 18/10,000 live births at the lowest-volume hospitals (P < .001). Similar trends were observed in rural hospitals, with rates increasing from 7-34/10,000 live births in low-volume rural hospitals (P < .001). CONCLUSION: These findings provide evidence for an inverse association between hospital obstetric volume and birth asphyxia.

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