Estimating the incidence and the economic burden of third and fourth-degree obstetric tears in the English NHS: an observational study using propensity score matching

TitreEstimating the incidence and the economic burden of third and fourth-degree obstetric tears in the English NHS: an observational study using propensity score matching
Publication TypeJournal Article
Year of Publication2017
AuthorsOrlovic, M, Carter, AWilliam, Marti, J, Mossialos, E
JournalBMJ Open
Volume7
Issue6
Paginatione015463
Date Published12/2017
URLhttp://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2016-015463https://syndication.highwire.org/content/doi/10.1136/bmjopen-2016-015463
DOI10.1136/bmjopen-2016-015463
ISSN2044-6055
Accession NumberPMID: 28606903
Mots-clésAdult, Anal Canal/injuries, Cesarean Section/statistics & numerical data, Cost of Illness, Costs and Cost Analysis, etrics, Female, gynaecology, Health Care, health economics, Humans, Incidence, Lacerations/economics, Lacerations/epidemiology, Length of Stay/economics, Obstetric Labor Complications/economics, Obstetric Labor Complications/epidemiology, Patient Safety, Perineum/injuries, Pregnancy, Propensity Score, quality in health care, Quality Indicators, Risk Factors, State Medicine, United Kingdom/epidemiology
Abstract

Obstetric care is a high-risk area in healthcare delivery, so it is essential to have up-to-date quantitative evidence in this area to inform policy decisions regarding these services. In light of this, the objective of this study is to investigate the incidence and economic burden of third and fourth-degree lacerations in the English National Health Service (NHS) using recent national data.
We used coded inpatient data from Hospital Episode Statistics (HES) for the financial years from 2010/2011 to 2013/2014 for all females that gave birth during that period in the English NHS. Using HES, we used pre-existing safety indicator algorithms to calculate the incidence of third and fourth-degree obstetric tears and employed a propensity score matching method to estimate the excess length of stay and economic burden associated with these events.
Observed rates per 1000 inpatient episodes in 2010/2011 and 2013/2014, respectively: Patient Safety Indicator-trauma during vaginal delivery with instrument (PSI 18)=84.16 and 91.24; trauma during vaginal delivery without instrument (PSI 19)=29.78 and 33.43; trauma during caesarean delivery (PSI 20)=3.61 and 4.56. Estimated overall (all PSIs) economic burden for 2010/2011=£10.7 million and for 2013/2014=£14.5 million, expressed in 2013/2014 prices.
Despite many initiatives targeting the quality of maternity care in the NHS, the incidence of third and fourth-degree lacerations has increased during the observed period which signals that quality improvement efforts in obstetric care may not be reducing incidence rates. Our conservative estimates of the financial burden of these events appear low relative to total NHS expenditure for these years.

WOS ID (UT)

000406391200159

Short TitleBMJ Open
Citation Key / SERVAL ID8247
Peer reviewRefereed

                         

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