Case mix adjusted variation in cesarean section rate in Sweden

Area of Science:

• Maternal Health
• Healthcare Quality Improvement
• Health Services Research

Background:

• Cesarean section (CS) rates are key indicators of maternity care performance and resource utilization.
• Comparing CS rates between hospitals necessitates case mix adjustment to account for patient variations.
• Understanding variations in CS rates is crucial for evaluating and improving healthcare delivery.

Purpose of the Study:

• To estimate the case mix adjusted variation in Cesarean section (CS) rates among hospitals in Sweden.
• To identify disparities in CS rates that persist after accounting for patient demographics and clinical factors.
• To provide data for potential improvements in Swedish maternity care.

Main Methods:

• Analysis of 139,756 deliveries across seven Swedish regions (67% of national total) from 2011-2012.
• Linking administrative data with the Medical Birth Register and population data.
• Utilizing 23 sociodemographic and clinical characteristics for case mix adjustment via logistic regression.

Main Results:

• Overall CS rate was 16.9%, with significant hospital-level variations (min-max 12.1%-22.6%) after adjustment.
• Adjusted odds ratios for CS varied from 0.62 to 1.45 across hospitals.
• Significant variations persisted in subgroups, including nulliparous and multiparous women with uncomplicated pregnancies.

Conclusions:

• Substantial differences in CS rates exist between Swedish hospitals, even after adjusting for case mix.
• These findings suggest potential for reducing interventions and optimizing resource use in childbirth care.
• Implementing best practice sharing and continuous monitoring can enhance the quality of maternity services.