295: Impact of rural hospitals closures on perinatal outcomes at a tertiary center

Abstract

There is a knowledge gap regarding perinatal outcomes at tertiary centers when rural hospitals close. The purpose of this study was to determine if maternal and neonatal outcomes were significantly different at a tertiary center following closure of rural hospitals (areas with a population of < 50,000). Over 3 years (2012 to 2015), 11 hospitals closed, and their deliveries were transferred to a tertiary center. Perinatal outcomes from January 2010 to December 2011 (Pre-Closure Period) and January 2015 to December 2016 (Post-Closure Period) were compared. The primary exposure was rural hospital closures. Outcomes included: hypertensive disorders of pregnancy (chronic hypertension, gestational hypertension, preeclampsia, and eclampsia), diabetes (including pre-existing diabetes and gestational diabetes), mode of delivery, transfusion and/or unplanned operation, length of stay, readmission postpartum, delivery < 37 weeks, 5 minute Apgar < 7, birthweight, NICU admission, and perinatal death (stillbirth or death within 27 days of birth). The number of deliveries at the tertiary center increased 37% following hospital closures (1,501 to 2,666 in 24 months Pre-and Post-Closure period). Maternal characteristics such as age, race, nulliparity, body mass index, substance abuse, and payer were similar in Pre- and Post-Closure cohorts. The rate of hypertensive disorders was also similar. The rate of cesarean delivery did not increase. Duration of maternal stay did differ significantly (p< 0.01) between the two periods (Table 1). The rate of preterm birth and newborns with low birthweights and macrosomia were similar. Though the rate of 5-minute Agar < 7 and NICU admission increased, neonatal mortality rate was similar (Table 2). Postpartum readmissions were similar (Table 1). Closure of rural hospital was associated with an increase in number of deliveries, maternal length of stay, and NICU admissions. There was no increase in maternal or neonatal morbidity.View Large Image Figure ViewerDownload Hi-res image Download (PPT)