1031 Severe maternal morbidity and other obstetric complications in illinois

Abstract

Studies of obstetric quality of care often focus on severe maternal morbidity (SMM) but rarely examine more common hemorrhagic, thrombotic, infectious, and operative complications. SMM comprises many heterogeneous conditions, and more specific metrics are needed to lead quality improvement initiatives. Thus, our objective was to characterize trends and risk markers for SMM and other delivery complications in Illinois hospitals. In this retrospective, population-based cohort study of deliveries at 127 Illinois hospitals (2016-2018), ICD-10 codes were used to describe the incidence of SMM and other complication rates by route of delivery. Poisson regression models were used to estimate the association of maternal sociodemographic and clinical characteristics as well as hospital characteristics with the likelihood of coded complications. Of 421,426 deliveries, the SMM rate was 0.76% overall (0.44% vaginal delivery [VD], 1.50% cesarean delivery [CD]) (Table 1). Other complications were documented in 8.62% of women with VD and 9.96% of women with CD. While SMM rates were stable over time, other VD complications increased 40% from 2016 to 2018 and other CD complications increased 34%. Patient age, minority race and ethnicity, and pre-existing and pregnancy-related clinical conditions were significantly associated with each complication outcome (Table 2). Hospital delivery volume, weekend admission, and medical record coding intensity (mean number of ICD-10 codes hospitals use for uncomplicated deliveries), were also significantly associated with complication incidence. Focusing on incidence of SMM significantly underestimates the incidence of maternal complications, which has increased over time. Additionally, the association of other complication incidence with hospital coding intensity raises questions about the reliability of using medical record coding to measure quality of care. New outcome measures based on more detailed clinical data as well as linked antepartum and postpartum care will be necessary to improve obstetric quality of care measurement.View Large Image Figure ViewerDownload Hi-res image Download (PPT)