Racial-ethnic disparities in potentially preventable complications after cesarean delivery in Maryland: an observational cohort study
Document Type
Journal Article
Publication Date
6-16-2022
Journal
BMC pregnancy and childbirth
Volume
22
Issue
1
DOI
10.1186/s12884-022-04818-5
Keywords
Cesarean delivery; Disparities; Healthcare quality; Obstetrics
Abstract
BACKGROUND: Potentially preventable complications are monitored as part of the Maryland Hospital Acquired Conditions Program and are used to adjust hospital reimbursement. Few studies have evaluated racial-ethnic disparities in potentially preventable complications. Our study objective was to explore whether racial-ethnic disparities in potentially preventable complications after Cesarean delivery exist in Maryland. METHODS: We performed a retrospective observational cohort study using data from the Maryland Health Services Cost Review Commission database. All patients having Cesarean delivery, who had race-ethnicity data between fiscal years 2016 and 2020 were included. Multivariable logistic regression modeling was performed to estimate risk-adjusted odds of having a potentially preventable complication in patients of different race-ethnicity. RESULTS: There were 101,608 patients who had Cesarean delivery in 33 hospitals during the study period and met study inclusion criteria. Among them, 1,772 patients (1.7%), experienced at least one potentially preventable complication. Patients who had a potentially preventable complication were older, had higher admission severity of illness, and had more government insurance. They also had more chronic hypertension and pre-eclampsia (both P<0.001). Median length of hospital stay was longer in patients who had a potentially preventable complications (4 days vs. 3 days, P<0.001) and median hospital charges were approximately $4,600 dollars higher, (P<0.001). The odds of having a potential preventable complication differed significantly by race-ethnicity group (P=0.05). Hispanic patients and Non-Hispanic Black patients had higher risk-adjusted odds of having a potentially preventable complication compared to Non-Hispanic White patients, OR=1.26 (95% CI=1.05 to 1.52) and OR=1.17 (95% CI=1.03 to 1.33) respectively. CONCLUSIONS: In Maryland a small percentage of patients undergoing Cesarean delivery experienced a potentially preventable complication with Hispanic and Non-Hispanic Black patients disproportionately impacted. Continued efforts are needed to reduce potentially preventable complications and obstetric disparities in Maryland.
APA Citation
Lankford, Allison; Roland, Laura; Jackson, Christopher; Chow, Jonathan; Keneally, Ryan; Jackson, Amanda; Douglas, Rundell; Berger, Jeffrey; and Mazzeffi, Michael, "Racial-ethnic disparities in potentially preventable complications after cesarean delivery in Maryland: an observational cohort study" (2022). GW Authored Works. Paper 1102.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/1102
Department
Anesthesiology and Critical Care Medicine