BACKGROUND A large literature search suggests a relationship between hospital/surgeon caseload volume and surgical complications. In this study, we describe associations between post-operative maternal complications following Caesarean section and provider caseload volume, provider years since graduation, and provider specialization, while adjusting for hospital volumes and patient characteristics. METHODS Our analysis is based on population-based discharge abstract data for the period of April 2004 to March 2014, linked to patient and physician universal coverage registry data. We consider all hospital admissions (N = 20,914) in New Brunswick, Canada, where a Caesarean Section surgery was recorded, as identified by a Canadian Classification of Health Intervention code of 5.MD.60.XX. We ran logistic regression models to identify the odds of occurrence of post-surgical complications during the hospital stay. RESULTS Roughly 2.6% of admissions had at least one of the following groups of complications: disseminated intravascular coagulation, postpartum sepsis, postpartum hemorrhage, and postpartum infection. The likelihood of complication was negatively associated with provider volume and provider years of experience, and positively associated with having a specialization other than maternal-fetal medicine or obstetrics and gynecology. CONCLUSIONS Our results suggest that measures of physician training and experience are associated with the likelihood of Caesarean Section complications. In the context of a rural province deciding on the number of rural hospitals to keep open, this suggests a trade off between the benefits of increased volume versus the increased travel time for patients.

中文翻译：

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剖腹产后提供者的数量和产妇并发症：基于人群的研究结果。

背景技术大量文献表明医院/外科医生的病例量与手术并发症之间存在关系。在这项研究中，我们描述了剖宫产术后产妇并发症与提供者病例数量，提供者毕业后的年限以及提供者专业化之间的关联，同时针对医院数量和患者特征进行了调整。方法我们的分析基于2004年4月至2014年3月期间基于人群的出院摘要数据，并与患者和医生的全民医疗保险注册数据关联。我们考虑了加拿大新不伦瑞克（New Brunswick）记录了剖腹产手术的所有医院入院（N = 20,914），这是由加拿大健康干预分类代码5.MD.60.XX确定的。我们运行了逻辑回归模型来确定住院期间发生手术后并发症的几率。结果约2.6％的入院患者至少患有以下一组并发症：弥散性血管内凝血，产后败血症，产后出血和产后感染。并发症的可能性与提供者的数量和提供者的经验负相关，并与除母胎医学或妇产科以外的专业相关而正相关。结论我们的结果表明，医师培训和经验的测量与剖宫产并发症的可能性有关。在农村省决定开放农村医院的数量的情况下，