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Original research
A ‘busy day’ effect on perinatal complications of delivery on weekends: a retrospective cohort study
  1. Jonathan M Snowden1,
  2. Katy Backes Kozhimannil2,
  3. Ifeoma Muoto3,
  4. Aaron B Caughey3,
  5. K John McConnell4
  1. 1Department of Obstetrics & Gynecology/Public Health & Preventive Medicine, Oregon Health & Science University, Portland, Oregon, USA
  2. 2Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
  3. 3Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon, USA
  4. 4Emergency Medicine, Oregon Health and Science University, Portland, Oregon, USA
  1. Correspondence to Dr Jonathan M Snowden, Department of Obstetrics & Gynecology/Public Health & Preventive Medicine, Oregon Health & Science University, 3181 SW Sam Jackson, Mail Code: L-466, Portland, OR 97239, USA; snowden{at}ohsu.edu

Abstract

Objective To evaluate whether busy days on a labour and delivery unit are associated with maternal and neonatal complications of childbirth in California hospitals, accounting for weekday/weekend births.

Design This is a population-based retrospective cohort study.

Setting Linked vital statistics/patient discharge data for California births between 2009 and 2010 from the Office of Statewide Health Planning and Development.

Participants All singleton, cephalic, non-anomalous California births between 2009 and 2010 (N=724 967).

Main outcomes The key exposure was high daily obstetric volume, defined as giving birth on a day when the number of births exceeded the hospital-specific 75th percentile of daily delivery volume. Outcomes were a range of maternal and neonatal complications.

Results Several maternal and neonatal complications were increased on high-volume days and weekends following adjustment for maternal demographics, annual hospital birth volume and teaching hospital status. For example, compared with low-volume weekdays, the odds of Apgar <7 on low-volume weekend days and high-volume weekend days were 11% (adjusted OR (aOR) 1.11, CI 1.03 to 1.21) and 29% higher (aOR 1.29, CI 1.10 to 1.52), respectively. High volume was associated with increased odds of neonatal seizures on weekdays (aOR 1.33, CI 1.01 to 1.71) and haemorrhage on weekends (aOR 1.11, CI 1.01 to 1.22). After accounting for between-hospital variation, weekend delivery remained significantly associated with increased odds of Apgar score <7, neonatal intensive care unit admission, prolonged maternal length of stay and the odds of neonatal seizures remained increased on high-volume weekdays.

Conclusions Our findings suggest that weekend delivery is a consistent risk factor for a range of perinatal complications and there may be variability in how well hospitals handle surges in volume.

  • Obstetrics and gynecology
  • Quality improvement
  • Health services research

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjqs-2016-005257

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    Footnotes

    • Contributors All authors have met the four authorship criteria as stated in the International Committee of Medical Journal Editors Recommendations for the Conduct, Reporting, Editing and Publication of Scholarly Work in Medical Journals.

    • Funding Institute of Child Health and Human Development (K99 HD079658-02).

    • Competing interests None declared.

    • Ethics approval The Institutional Review Board at Oregon Health & Science University.

    • Provenance and peer review Not commissioned; externally peer reviewed.