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Am J Obstet Gynecol. 2007 Jun;196(6):526.e1-5.

Variation in the rates of operative delivery in the United States.

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1
Hospital Corporation of America, Division of Perinatal Safety, Nashville, TN, USA.

Abstract

OBJECTIVES:

This study was undertaken to examine the national and regional rates of operative delivery among almost one quarter million births in a single year in the nation's largest healthcare delivery system, using variation as an arbiter of the quality of decision making.

STUDY DESIGN:

We compared the variation in rates of primary cesarean and operative vaginal delivery in facilities of the Hospital Corporation of America during the year 2004.

RESULTS:

In 124 facilities representing almost 220,000 births during a 1-year period, the primary cesarean and operative vaginal delivery rates were 19% +/- 5% (range 9-37) and 7% +/- 4% (range 1-23). Within individual geographic regions, we consistently found variations of 200-300% in rates of primary cesarean delivery and variations approximating an order of magnitude for operative vaginal delivery.

CONCLUSION:

Within broad upper and lower limits, rates of operative delivery in the United States are highly variable and suggest a pattern of almost random decision making. This reflects a lack of sufficient reliable, outcomes-based data to guide clinical decision making.

PMID:
17547880
DOI:
10.1016/j.ajog.2007.01.024
[Indexed for MEDLINE]

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