• Jack Needleman and Ann F Minnick.
• Department of Health Services, UCLA School of Public Health, Los Angeles, CA, USA.
• Health Serv Res. 2009 Apr 1;44(2 Pt 1):464-82.

ObjectiveDetermine the ability of anesthesia provider model and hospital resources to explain maternal outcome variation.Data Source/Study Setting1,141,641 obstetrical patients from 369 hospitals that reported at least one live birth in 2002 in six representative states.Study DesignLogistic regression of death, anesthesia complication, nonanesthesia maternal complication, and obstetrical trauma for all patients and those having cesarean deliveries on anesthesia provider model, obstetrical and anesthesia, and patient variables.Data Collection/Extraction MethodsData was assembled from information given by hospitals to state agencies and from a 2004 survey of obstetrical organization resources.Principal FindingsAnesthesia complication rates in anesthesiologist-only hospitals were 0.27 percent compared with 0.23 percent in certified registered nurse anesthetist (CRNA) only hospitals. Rates among other provider models varied from 0.24 to 0.37 percent with none statistically different from the anesthesiologist-only hospitals. A similar pattern was observed for rates of other outcomes. Multivariate analysis found no systematic differences between hospitals with anesthesiologist-only models and models using CRNAs. There was no consistent pattern of association of other hospital or patient characteristics with outcomes.ConclusionHospitals that use only CRNAs, or a combination of CRNAs and anesthesiologists, do not have systematically poorer maternal outcomes compared with hospitals using anesthesiologist-only models.

28 keywords...

hide…