Hospital and Individual Variations of Surgical Errors and Complications in Caesarean Section in the United States

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Background: Caesarean Section (CS) is the most common inpatient surgery performed internationally. Although CS is typically performed to prevent adverse maternal and fetal outcomes, there is still a risk of surgical errors and complications. This study examined maternal and hospital risk factors associated with errors and complications following CS in the United States (US). Methods: Data were obtained from the 2012-2014 National Inpatient Sample, a deidentified database containing a random sample of 20% of hospital discharges in the US. Surgical errors (e.g. foreign body retained during surgery) can be the result of human error, while complications (e.g. infection) can be due to external factors such as preexisting comorbidities. The overall incidence of surgical errors and complications in CS was calculated. Bivariate analysis examined the association between surgical errors and complications in CS, and potential individual and hospital level covariates. Multilevel logistic modelling examined the association between individual (e.g. race) and hospital (e.g. CS volume), and errors and complications. Results: Among 648,584 CS hospitalizations, 1.98% (95%CI: 1.95%-2.01%) and 9.67% (95%CI: 9.59%-9.74%) of women had an error or complication, respectively. The odds of developing a complication were 15.90 (95%CI: 15.33-16.49) if an error also occurred. Both individual- and hospital-level factors were associated with errors and complications. Women with Medicaid had increased odds of errors (OR: 1.40 (95%CI:1.37-1.43)) but lower odds of complications (OR: 0.89 (95%CI:0.88-0.90)), compared to women with private insurance. Compared to non-Hispanic white women, iii all races had lower odds of error, and only non-Hispanic black women had greater odds of complications (OR: 1.14 (95%CI:1.13-1.16)). Delivering prior to 37 weeks of gestation decreased the odds of errors (OR: 0.73 (95%CI:0.71-0.76)) and maternal complications (OR: 0.73 (95%CI:0.72-0.74)). Similarly, rural hospitals had lower odds of surgical errors (OR: 0.59 (95%CI: 0.56-0.62)) and complications (OR: 0.61 (95%CI: 0.59-0.62)) while hospitals with a large bed size had greater odds of errors and complications than medium bed size hospitals, at 1.13 (95%CI:1.09-1.17), and 1.13 (95%CI:1.11-1.15), respectively. Conclusions: This study identified specific risk factors for errors and complications that can be further examined through quality improvement frameworks to reduce the incidence of adverse maternal events during CS.
c-sections, complications, adverse events, individual factors, hospital factors, caesarean section, maternal health, surgical outcomes, patient safety, administrative data
Author, M. S. (2018). Hospital and Individual Variations of Surgical Errors and Complications in Caesarean Section in the United States (Master's thesis, University of Calgary, Calgary, Canada). Retrieved from doi:10.11575/PRISM/31977