(921) Utilizing a Co-Morbidity Scoring System to Improve Outcomes in Patients with Common Obstetric Co-Morbidities

Objective: The obstetric co-morbidity index (OB-CMI) is known to predict maternal morbidity and encompasses a wide range of conditions inclusive of severe co-morbidities like heart disease and placenta accreta, and more common co-morbidities such as obesity and asthma. While obstetricians are readily aware of the morbidity risk in patients with major co-morbidities, the impact of utilizing OB-CMI scores on L&D to assess risk in patients without the highest-risk co-morbidities is unknown.

Study Design:

This prospective cohort study was performed at a tertiary-care hospital and examined morbidity rates (see Table for definition) for 1-year before (2020) and 1-year after (2021) implementation of OB-CMI calculation as standard of care on L&D (2020 v. 2021). OB-CMI scores were calculated at the time of delivery admission for all patients and scores > 6 prompted an interdisciplinary huddle to discuss risk-reduction strategies. For this analysis, all patients with a severe co-morbidity (see Table) were excluded. Data were analyzed in a multivariable logistic regression model including OB-CMI, cohort year, and their interaction.

Results: There were a total of 8197 patients in the entire sample and 6493 patients met criteria for this analysis (3283 pre/3210 post) with median OB-CMI of 2 in both groups and no significant differences in demographics or co-morbidities (Table). The rate of the primary outcome was 13.0% in 2020 compared to 13.7% in 2021 (p=0.37).  As noted in the figure, on adjusted analysis, the same OB-CMI score had a lower predicted probability of SMM in 2021 vs. 2020, though it did not reach statistical significance (OR 1.15, p=0.29).

Conclusion:

While the intervention of calculating OB-CMI scores on L&D did not significantly reduce SMM in this sub-population without severe co-morbidities in a tertiary center, these data suggest that using the score clinically may play a role in reducing SMM particularly in a lower risk clinical setting.