Factors associated with cesarean delivery rates: a single-institution experience

Abstract

BackgroundThe aim of this study was to identify factors associated with variability in Cesarean delivery (CD) rates amongst providers at a single institution.MethodsA retrospective cohort analysis was carried out on all births at NYU Langone Medical Center from 2005–2013. Data was collected for subjects and linked to diagnosis codes for singleton and twin deliveries. Descriptive characteristics were generated for all deliveries, and inferential analysis was performed including multiple covariates for singleton deliveries in the 2010–2013 cohort, including both univariate and multivariate regression analyses to identify factors associated with higher CD rates.Results37,692 deliveries were identified at our institution during the study period, performed by 88 unique providers. The mean CD rate was 29.6%, with a range for individual physicians from 9.9% to 75.6%. In multivariate regression analysis, CD rate was directly correlated with average patient age, physician male gender, proportion of high-risk deliveries, and Maternal-Fetal Medicine specialty, and it was inversely correlated with total number of deliveries by physician and forceps delivery rate. There was no significant difference in CD rates between group and solo practices. Within the same group practice, each member’s CD rate was strongly correlated with the average CD rate of the group.ConclusionOur study demonstrates the wide range of CD rates for providers practicing within the same institution and reiterates the association of CD rates with patient age, high-risk pregnancy, and provider volume. Among operative vaginal deliveries, forceps delivery rate was associated with lower CD rates whereas vacuum delivery rate was not. Despite these findings, practice patterns within individual practices appear to contribute significantly to the wide range of CD rates.

Caesarean Section rate amongst Obstetricians at a tertiary-care hospital of Karachi

“…As the feto-maternal specialists deal with high risk patients having medical or surgical co-morbids, the risk of CS is expected to be higher in this group as compared to other consultants. 6 The CS rate, in our study was slightly lesser among high-risk group of consultants though this was not statistically significant. This may be because, we selected term pregnancies and several high risk patients may need delivery before 37 completed weeks.…”

“… 3 - 5 In order to modify the practices and other factors affecting the mode of delivery (MOD)many centers use CS rate as a quality indicator especially among Nulliparous at Term and Singleton pregnancies with Vertex presentation (NTSV). 6 The rate of CS among NTSV varies widely, from 10.3% to 34.2%. 3 , 7 - 9 NTSV being low risk is most eligible for vaginal birth.…”

“…Variations in practices are seen in conditions like dysfunctional labour and non-reassuring fetal status. 6 This variation is minimized in developed countries by implementation of guidelines to standardize the clinical practices. 11 …”

Is it possible to reverse the epidemics of unnecessary cesarean sections?

“…McClelland et al 7 conducted a study to identify the variability-associated factors in the rate of cesarean sections at a single site and observed a broad range of cesarean section rates among obstetricians.…”

La epidemia de cesáreas no justificadas, ¿podremos revertirla?

“…McClelland et al, 7 realizaron un estudio para identificar los factores asociados con la variabilidad en las tasas de parto por cesárea en una sola institución y observaron una amplia oscilación de las tasas de cesáreas entre los obstetras.…”