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.