575: Hospital variations in the use of forceps assisted delivery - results from a state-wide analysis

Use of forceps assisted delivery (FAD) has been decreasing. In order to understand broad-based patterns in FAD, we sought to describe hospital variations in the use of FAD on a state-wide level. We performed a population-based retrospective cohort study using linked California birth and hospital discharge data from 2008 to 2012. The study population included all singleton term liveborn infants delivered vaginally and their mothers. Delivery was categorized as unassisted vaginal birth, FAD or vacuum assisted delivery (VAD). The rates of FAD were calculated for hospitals, and described by hospital characteristics including FAD volume and teaching status. We further compared the rates of FAD with VAD per hospital. For 2008-2012 there were 1,557,039 vaginal births across 276 hospitals. FAD occurred in 0.3% of vaginal births during the study period. 59 hospitals (21%) had no FAD over the study period and 80% of hospitals had FAD volumes of no more than 5 on average per year (Table 1). The largest volume hospital (a teaching hospital) performed almost 14% of all FAD in the state. The 16 highest volume hospitals represented 5.8% of all hospitals, yet accounted for 50% of all FAD. Among these 16 hospitals, the rate of FAD varied from 0.4% to 14% (Figure 1) with an average volume per year ranging from 15 to 150. Furthermore, the ratio of the percent of FAD to VAD (% FAD/% VAD) ranged from 0.1 to 7.1, with only two hospitals performing more FAD than VAD (ratio > 1). Less than 6% of hospitals account for half of FAD in California, and among these hospitals the volume of FAD varies substantially. These data illustrate that use of forceps assisted delivery is concentrated among a limited number of institutions, and possibly providers.View Large Image Figure ViewerDownload Hi-res image Download (PPT)