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Anesthesia workforce density and failure-to-rescue from maternal morbidity.
Abstract Number: T1B-134
Abstract Type: Original Research
Background: Each year in the United States, 50 000 parturients experience a life-threatening complication and 700 die (1). Progression from a complication to death is defined as a failure-to-rescue (FTR). FTR captures the premise that not all complications are avoidable but that systems should allow recognition and response to these complications to prevent death (2). Research indicates that higher density of obstetricians at state-level is associated with decreased maternal mortality (3). Despite their growing involvement in maternal care, the association between anesthesiologists’ density and maternal outcomes has not been examined. This study tested the hypothesis that a higher density of anesthesia providers is associated with a lower FTR from maternal morbidity.
Methods: This retrospective study analyzed maternal morbidity and mortality data from delivery and postdelivery discharges of the National Inpatient Sample (NIS) 2012-2015, a 20% national representative sample. The CDC definition of maternal morbidity was used (4). Numbers of obstetricians, midwives, physician anesthesiologists and certified registered nurse anesthetists (CRNA) per 1000 births in the 9 census divisions were abstracted from the Area Health Resources file 2012-2015. The adjusted odds ratio (aOR) of FTR associated with provider density was estimated using robust logistic regression.
Results: During the study period, the NIS recorded a total of 57,446 parturients with maternal morbidity, including 202 deaths (FTR rate: 3.5 per 1000; 95% CI, 3.0-4.0). The lowest FTR rate was in the Mountain Division (1.8 per 1000) and the highest in the South Atlantic Division (5.3 per 1000). Both CRNA density and proportion of CRNAs among anesthesia providers were significantly higher in discharges recording FTR than in discharges not recording FTR (Table 1). Obstetricians’, midwifes’, and physician anesthesiologists’ densities did not differ between discharges with and without FTR. After adjustment, only CRNA density was associated with FTR (aOR 1.05; 95% CI, 1.02-1.09).
Conclusions: CRNA density at the census division level is associated with increased FTR from maternal morbidity. The underlying mechanisms of this unexpected association remain to be determined.
1. Main, Obstet Gynecol 2015;125:938-47
2. Friedman, Am J Obstet Gynecol 2016;215:795.e1-14
3. Sullivan, Am J Obstet Gynecol 2005;193:1083-8
4. Callaghan, Obstet Gynecol 2012;120:1029-36