Perinatal Outcomes of High-Risk Patients Delivered by Resident Versus Private Practice Physicians [A138

Abstract

INTRODUCTION: This study compared perinatal outcomes of deliveries performed by resident and private practice physicians. METHODS: This is a secondary analysis of a large institutional review board‒approved, National Institutes of Health–funded retrospective cohort study of pregnant patients with chronic hypertension, diabetes, and/or fetal growth restriction who delivered singletons at a tertiary-care maternity hospital from January 2002 to March 2013. Maternal and neonatal outcomes of deliveries by resident physicians were compared to those of private practice physicians. The primary outcome was mode of delivery. RESULTS: The cohort included 9,744 deliveries: 1,928 resident and 7,816 private. Compared to private patients, resident patients were younger; more likely to be non-White, multiparous, or cigarette-smoking; and more likely to have public or no insurance, low BMI, or chronic hypertension. Private practice patients were more likely to have fetal macrosomia and diabetes. After adjusting for these factors, resident patients had 18% lower risk of cesarean delivery (CD) overall (aRR, 0.82; 95% CI, 0.76–0.88), driven by a 45% reduction in elective CD (aRR, 0.55; 95% CI, 0.43–0.70). Resident patients also had lower rates of episiotomy (aRR, 0.71; 95% CI, 0.58–0.88), but higher rates of endometritis (aRR, 1.93; 95% CI, 1.49–2.49) and NICU admission (aRR, 1.19; 95% CI, 1.04–1.36). CONCLUSION: In this cohort of high-risk pregnant patients, delivery by resident physicians was associated with a reduction in CD, particularly elective CD, and episiotomy. A focus on understanding the choice of private practice patients to undergo elective cesarean delivery and their providers to perform elective cesarean delivery may help reduce preventable morbidity.