Monitoring Obstetric Anesthesia Safety across Hospitals through Multilevel Modeling

Anesthesiology
Jean Guglielminotti, Guohua Li

Abstract

The rate of anesthesia-related adverse events (ARAEs) is recommended for monitoring patient safety across hospitals. To ensure comparability, it is adjusted for patients' characteristics with logistic models (i.e., risk adjustment). The rate adjusted for patient-level characteristics and hospital affiliation through multilevel modeling is suggested as a better metric. This study aims to assess a multilevel model-based rate of ARAEs. Data were obtained from the State Inpatient Database for New York 2008-2011. Discharge records for labor and delivery and ARAEs were identified with International Classification of Diseases, Ninth Revision, Clinical Modification codes. The rate of ARAEs for each hospital during 2008-2009 was calculated using both the multilevel and the logistic modeling approaches. Performance of the two methods was assessed with (1) interhospital variability measured by the SD of the rates; (2) reclassification of hospitals; and (3) prediction of hospital performance in 2010-2011. Rankability of each hospital was assessed with the multilevel model. The study involved 466,442 discharge records in 2008-2009 from 144 hospitals. The overall observed rate of ARAEs in 2008-2009 was 4.62 per 1,000 discharges [95% CI, 4.43...Continue Reading

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Citations

Feb 18, 2017·Anesthesia and Analgesia·Philip E Hess
Mar 10, 2017·Current Opinion in Anaesthesiology·Thomas T KlumpnerSachin Kheterpal
May 18, 2021·International Journal of Obstetric Anesthesia·J GuglielminottiG Li
May 18, 2020·The Journal of Thoracic and Cardiovascular Surgery·Aaron MittelMay Hua

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