April 21st, 2018

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Title:
Association Between Physician Experience and Obstetric Outcomes After Vacuum Delivery
Authors:  Emily S. Miller, M.D., M.P.H., Ashley Battarbee, M.D., Ariel Moser, M.P.H., and Dana R. Gossett, M.D., MSCI
  OBJECTIVE: To estimate the association between obstetrician experience and the incidence of severe perineal lacerations and failed vacuum attempts.

STUDY DESIGN: This is a retrospective cohort of vacuum deliveries performed at a tertiary-care hospital. Provider experience was examined both by attending years of practice and year of residency training (if a trainee participated in the delivery). Outcomes examined included severe perineal lacerations (3rd or 4th degree) and failed vacuum deliveries. Multilevel multivariable analyses were performed to control for both individual patient-level characteristics and the delivery provider.

RESULTS: A total of 134 attending obstetricians performed 1,852 vacuum-assisted deliveries with a Kiwi or MityVac device. Of those, 248 women (13.4%) had a severe perineal laceration and 115 (6.2%) had a failed vacuum. Rates of severe perineal lacerations were not associated with any measure of provider experience. When controlling for patient-level variables such as station (low or outlet), fetal head position, indication for vacuum, and parity, we found that increasing attending years of practice (in 5-year increments) (aOR 0.80, 95% CI 0.66–0.97) and increasing resident year of training (aOR 0.60, 95% CI 0.46–0.79) were inversely associated with failed vacuum deliveries.

CONCLUSION: Obstetrician experience is not associated with severe perineal lacerations. Overall obstetric attending experience and resident year of training are significantly inversely associated with failed vacuum deliveries.
Keywords:  obstetric delivery; obstetrician; obstetrics; operative vaginal delivery; perineal laceration; vacuum extraction, obstetrical; volume
   
   
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