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Hospital contribution to variation in rates of vaginal birth after cesarean

Jourdan E Triebwasser^1,2, Neil S Kamdar^3,4,5,6, Elizabeth S Langen³

¹University of Michigan, Department of Obstetrics and Gynecology, Ann Arbor, MI, USA. jourdan.triebwasser@pennmedicine.upenn.edu.

Journal of Perinatology : Official Journal of the California Perinatal Association

|April 7, 2019

Abstract

Objective:

To determine the influence of delivery hospital on the rate of vaginal birth after cesarean (VBAC).

Study Design:

This retrospective cohort study used claims data from Blue Cross and Blue Shield of Michigan. Women with a prior cesarean and a singleton livebirth between 2012 and 2016 were included. We calculated the hospital-specific risk-standardized VBAC rates and median odds ratio as a measure of variation.

Result:

Hospital-level adjusted rates varied nearly tenfold (3.7%-35.5%). Compared to the lowest volume hospitals (1st quartile), the likelihood of VBAC increased for those in the 2nd (adjusted OR 2.75 [95% CI 1.23-6.17]), 3rd (adjusted OR 3.73 [95% CI 1.59-8.75]), and 4th quartiles (adjusted OR 2.9 [95% CI 1.11-7.72]). The median OR suggested significant variation by hospital after adjustment.

Conclusion:

The delivery hospital itself explains a large amount of the variation in rates of VBAC after adjustment for patient and hospital characteristics.

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