Supplemental Digital Content 2
SDC 2-1: Distribution of the Annual Number of Cesarean Deliveries in the 20 Hospitals with Less than 100 Annual Cesarean Deliveries.
These 20 hospitals comprised 3,311 discharges (1.4%) and 70 adverse events (4.5%); 14 of these 20 hospitals had a rankability < 0.7 (70%) and made up 42% of the 33 hospitals of the study sample with a rankability < 0.7. Hospitals with a rankability less than 0.7 are in red.
Rankability is indicated in the superscript number.
SDC 2-2: Calibration Plot of the Multilevel Model for ARAEs
The predicted probability of anesthesia-related adverse events is calculated with the final
multilevel model and is categorized according to deciles. The plot displays the observed probability with its 95% confidence interval and the expected probability of anesthesia-related adverse events according to deciles of predicted probability. The calibration is considered good if, for each decile, the predicted probability is included in the 95% confidence interval of the observed probability.
SDC 2-3: Results of the Logistic Regression Model Estimating the Risk of Anesthesia-related Adverse Events Based on the Hospital Outlier Status
The logistic model includes the occurrence of an anesthesia-related adverse event as the dependent variable, and the outlier status based on the hospital odds ratio and the other characteristics identified in the final multilevel model as independent variables. The c-index of the model is 0.68 (95% CI: 0.66-0.69) and the Hosmer-Lemeshow test P-value 0.17.
Odds ratio
(95% confidence
interval)
P-value
Hospital outlier status
- Low outlier Reference Referenc
e
- Average outlier 2.28 (1.74-3.01) < 0.0001
- High outlier 5.92 (4.50-7.80) < 0.0001
Charlson comorbidity index ≥ 1 1.20 (1.00-1.45) 0.05
Multiple gestation 1.16 (0.94-1.43) 0.16
General anesthesia 1.33 (1.13-1.58) 0.0008
Postpartum hemorrhage 1.44 (1.10-1.88) 0.008
Hospital annual number of cesarean deliveries <
200
2.34 (2.00-2.72) < 0.0001 Reporting index (per 1 increase per discharge) 1.15 (1.12-1.19) < 0.0001