Office hours and caesarean section: systematic review and Meta-analysis

Area of Science:

• Obstetrics and Gynecology
• Health Services Research
• Medical Decision Making

Background:

• Physician factors like convenience and incentives may influence unnecessary caesarean births.
• Delivery during standard office hours can serve as a proxy to evaluate these non-clinical influences.

Purpose of the Study:

• To investigate the impact of office hours on the decision-making process for caesarean deliveries.
• To compare the odds of caesarean delivery during office hours versus out-of-office hours.

Main Methods:

• A comprehensive literature search was conducted across multiple databases (CINAHL, PubMed, Scopus, etc.) up to August 2021.
• Meta-analysis and descriptive synthesis were used to analyze data from selected studies, focusing on odds ratios for caesarean sections during office versus out-of-office hours.

Main Results:

• Meta-analysis revealed significantly higher odds of overall caesarean sections during weekdays compared to weekends and Sundays.
• The effect on emergency caesarean sections was minimal, with only a slight increase observed in unadjusted analyses.
• Subgroup analyses and descriptive synthesis indicated similar trends for other office hours-related outcomes.

Conclusions:

• Delivery during office hours is associated with increased odds of overall caesarean sections.
• Non-clinical factors related to office hours appear to influence the decision for caesarean delivery.
• Further investigation into the
• office hours effect
• is warranted to potentially improve delivery care systems.