Provider volume and maternal complications after Caesarean section: results from a population-based study.

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.

Association Between a Comprehensive Movement Assessment and Metabolically Healthy Overweight Obese Adults.

Physical activity (PA) and sedentary behavior are associated with metabolic health in overweight and obese individuals. However, the role of comprehensive health-related movement guidelines on PA, recreational screen time, and sleep among Metabolically Healthy Overweight-Obese (MHO) individuals is unknown. We investigated differences in comprehensive movement assessment scores between adults classified as MHO or Non-MHO. The sample included 513 adults (46.2% male), aged 19 to 85 years, body mass index (BMI) ≥ 25, from cycle 2005-2006 of the National Health and Nutrition Examination Survey. Comprehensive movement assessment outcomes were defined as meeting modified 24-Hour Movement Guidelines criteria, with thresholds adapted for adults. 13.8% of participants were MHO (normal serum glucose, triglycerides, HDL-cholesterol, and systolic and diastolic blood pressure). Only 1.4% of MHO participants met all guidelines. MHO and Non-MHO participants had similar comprehensive movement assessment scores (MHO: 18.3% vs. Non-MHO: 10.9%; p = 0.072). MHO individuals had less continuous recreational screen time than Non-MHO individuals (1.8 ± 1.4 hrs/day vs. 2.5 ± 1.6 hrs/day; p < 0.001). Meeting the recreational screen time recommendation was the only variable associated with the MHO phenotype (OR:4.84 95%CI: 2.33-10.07). This association remained after adjusting for age, sex, ethnicity, education, and BMI (OR: 3.53 95%CI: 1.72-7.24). Our results suggest the importance of limiting recreational screen time in adults to optimize cardiometabolic risk profile in individuals living with overweight or obesity. Using movement guidelines with a screen time component to assess the risk associated with health outcomes in adults appears to provide a better assessment.

Physical Activity and Sedentary Patterns among Metabolically Healthy Individuals Living with Obesity.

BACKGROUND: Some individuals living with obesity are free from typical cardiometabolic risk factors and are termed metabolically healthy obese (MHO). The patterns of physical activity and sedentary behaviors among MHO are currently unknown. METHODS: This study includes 414 youth (12-18 years old), 802 adults (19-44 years old), and 1230 older adults (45-85 years old) living with obesity from the 2003-2004 or 2005-2006 NHANES cycles. Time spent in bouts of 1, 5, 10, 30, and 60 minutes for moderate-to-vigorous physical activity (MVPA) and sedentary time was measured objectively using accelerometers. Participants were categorized as MHO if they had no cardiometabolic risk factors above the identified thresholds (triglycerides, high-density lipoprotein cholesterol, systolic blood pressure, diastolic blood pressure, and glucose). RESULTS: The proportion of MHO was 19%, 14%, and 12% in youth, adults, and older adults, respectively. MHO adults displayed a higher 1-minute bout of MVPA per day compared to non-MHO (p = 0.02), but no difference was observed for MVPA and sedentary behavior patterns for youth and older adults. When adjusted for confounders, all bouts of sedentary behavior patterns in youth were significantly associated with being classified as MHO. CONCLUSION: This study suggests that greater sedentary time is associated with cardiometabolic risk factors in youth even if they are physically active.