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Published on: June 6, 2020
Variation in the Nulliparous, Term, Singleton, Vertex Cesarean Delivery Rate.
Daniel N Pasko1, Paula McGee, William A Grobman
1Departments of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama; Northwestern University, Chicago, Illinois; MetroHealth Medical Center-Case Western Reserve University, Cleveland, Ohio; Columbia University, New York, New York; the University of Utah Health Sciences Center, Salt Lake City, Utah; the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; the University of Texas Southwestern Medical Center, Dallas, Texas; the University of Pittsburgh, Pittsburgh, Pennsylvania; The Ohio State University, Columbus, Ohio; the University of Texas Medical Branch, Galveston, Texas; Wayne State University, Detroit, Michigan; Brown University, Providence, Rhode Island; the University of Texas Health Science Center at Houston, McGovern Medical School-Children's Memorial Hermann Hospital, Houston, Texas; Oregon Health & Science University, Portland, Oregon; the George Washington University Biostatistics Center, Washington, DC; and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland.
Patient factors explain 24% of cesarean delivery variation in nulliparous, term, singleton, vertex births. However, most variation in cesarean delivery rates remains unexplained by patient or hospital characteristics.
Area of Science:
- Obstetrics and Gynecology
- Health Services Research
- Epidemiology
Background:
- Cesarean delivery rates vary significantly across hospitals.
- Understanding the drivers of this variation is crucial for improving obstetric care quality.
- Nulliparous, term, singleton, vertex (NTSV) deliveries represent a key population for analyzing cesarean delivery trends.
Purpose of the Study:
- To determine the extent to which patient-related factors and healthcare provider-hospital characteristics contribute to variations in NTSV cesarean delivery rates.
- To assess the impact of risk adjustment on hospital rankings for NTSV cesarean delivery frequency.
Main Methods:
- Secondary analysis of a multi-center cohort (115,502 mother-neonate pairs).
- Included 38,275 nulliparous women delivering a singleton in vertex presentation at term.
- Hierarchical logistic regression used to assess variation attributable to patient and hospital factors.
Main Results:
- Median NTSV cesarean delivery frequency was 25.3% (range 15.0%-35.2%).
- Patient characteristics explained 24% of the variation in NTSV cesarean delivery rates.
- Analyzed healthcare provider-hospital characteristics were not significantly associated with cesarean delivery frequency.
Conclusions:
- Patient factors partially explain NTSV cesarean delivery variation, but the majority remains unexplained.
- Risk adjustment impacts hospital rankings, highlighting the need to account for case mix.
- Further research is needed to identify other factors contributing to cesarean delivery variation.
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