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J Perinatol. 2018 Feb;38(2):127-131. doi: 10.1038/jp.2017.173. Epub 2017 Nov 9.

Hospital volume and cesarean delivery among low-risk women in a nationwide sample.

Author information

1
Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA.
2
Harvard Medical School, Boston, MA, USA.
3
The Deborah Kelly Center for Outcomes Research, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA.

Abstract

OBJECTIVE:

We sought to determine if hospital delivery volume was associated with a patient's risk for cesarean delivery in low-risk women.

STUDY DESIGN:

This study retrospectively examines a cohort of 1 657 495 deliveries identified in the 2013 Nationwide Readmissions Database. Hospitals were stratified by delivery volume quartiles. Low-risk patients were identified using the Society for Maternal-Fetal Medicine definition (n=845 056). A multivariable logistic regression accounting for hospital-level clustering was constructed to assess the factors affecting a patient's odds for cesarean delivery.

RESULTS:

The range of cesarean delivery rates was 2.4-51.2% among low-risk patients, and the median was 16.5% (IQR 12.8-20.5%). The cesarean delivery rate was higher in the top two-volume-quartile hospitals (17.4 and 18.2%) compared to the bottom quartiles (16.4 and 16.3%) (P<0.001). Hospital volume was not associated with a patient's odds for cesarean delivery after adjusting for patient and other hospital characteristics (P=0.188).

CONCLUSION:

Hospital delivery volume is not an independent predictor of cesarean delivery in this population.

PMID:
29120454
DOI:
10.1038/jp.2017.173

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