Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2017 Jun 12;7(6):e015463.
doi: 10.1136/bmjopen-2016-015463.

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

Martina Orlovic  1 , Alexander William Carter  1 , Joachim Marti  1 , Elias Mossialos  1
Affiliations
Observational Study

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

Martina Orlovic et al. BMJ Open. .

Abstract

Objective: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: etrics; gynaecology; health economics; patient safety; quality in health care.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Monetary value of excess LOS.LOS, length of stay; PSI, Patient Safety Indicators.
See this image and copyright information in PMC

References

    1. Vincent C. Patient safety. London: Elsevier, 2006.
    1. WHO. Conceptual framework for the International classification for Patient Safety, Version 1.1, Final Technical Report January 2009. 3 Geneva, 2009.
    1. Kohn LT, Corrigan J, Donaldson MS. To Err is human: building a Safer Health System. Washington, D.C.: National Academy Press, 2000. - PubMed
    1. Wang X, Liu K, You LM, et al. The relationship between patient safety culture and adverse events: a questionnaire survey. Int J Nurs Stud 2014;51:1114–22. 10.1016/j.ijnurstu.2013.12.007 - DOI - PubMed
    1. Mardon RE, Khanna K, Sorra J, et al. Exploring relationships between hospital patient safety culture and adverse events. J Patient Saf 2010;6:226–32. 10.1097/PTS.0b013e3181fd1a00 - DOI - PubMed

Publication types

MeSH terms