Caesarean sections in teaching hospitals: systematic review and meta-analysis of hospitals in 22 countries

Hoxha, Ilir; Zhubi, Esra; Grezda, Krenare; Kryeziu, Blerta; Bunjaku, Jeta; Sadiku, Fitim; Agahi, Riaz; Lungu, Daniel Adrian; Bonciani, Manila; Little, George A.

doi:10.1136/bmjopen-2020-042076

Cited by 6 publications

(5 citation statements)

References 72 publications

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“…The study was modelled after our previous meta-analyses [18,19,21,22,35] and was also designed to adhere to existing guidelines: the Preferred Reporting Items for Systematic Reviews (PRISMA), [36,37] Conducting Systematic Reviews and Meta-Analyses of Observational Studies of Aetiology (COSMOS-E) [38] and Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines [39]. Prior to study initiation, the protocol was submitted to Prospero (CRD42020158434).…”

Section: Methodsmentioning

confidence: 99%

“…The association of CS with health system factors has been investigated, and various factors appear to influence CS rates, including country-level factors [4,12,15,16] such as cultural preferences, insurance systems, payment practices; [4,[17][18][19] hospital-level characteristics, such as for-profit or teaching status [17,[19][20][21] and micro-level factors, i.e. factors related to physician, [22] patient and clinical units [17,23].…”

Section: Introductionmentioning

confidence: 99%

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

Hoxha

Lama²,

Bunjaku³

et al. 2022

Res Health Serv Reg

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Background Unnecessary caesarean births may be affected by physician factors, such as preferences, incentives and convenience. Delivery during office hours can be a valuable proxy for measuring such effects. Objective To determine the effect of office hours on the decision for caesarean delivery by assessing the odds of caesarean during office hours compared to out-of-office hours. Search strategy We searched CINAHL, ClinicalTrials.gov, The Cochrane Library, PubMed, Scopus and Web of Science from the beginning of records through August 2021. Data collection and analysis Search results were screened by three researchers. First, we selected studies that reported odds ratios of caesareans, or data allowing their calculation, for office and out-of-office hours. We extracted data on the study population, study design, data sources, setting, type of caesarean section, statistical analysis, and outcome measures. For groups reporting the same outcome, we performed a standard inverse-variance random-effects meta-analysis, which enabled us to calculate the overall odds ratios for each group. For groups reporting varying outcomes, we performed descriptive analysis. Main results Meta-analysis of weekday vs weekend for any caesarean section showed higher odds of caesarean during weekdays in adjusted analysis 1.40 (95%CI 1.13, 1.72 from 1,952,691 births). A similar effect was observed in the weekday vs Sunday comparison (1.39, 95%CI 1.10, 1.75, 150,932 births). A lower effect was observed for emergency CS, with a slight increase in adjusted analysis (1.06, 95%CI 0.90, 1.26, 2,622,772 births) and a slightly higher increase in unadjusted analysis (1.15, 95%CI 1.03, 1.29, 12,591,485 births). Similar trends were observed in subgroup analyses and descriptive synthesis of studies examining other office hours outcomes. Conclusions Delivery during office hours is associated with higher odds for overall caesarean sections and little to no effect for emergency caesarean. Non-clinical factors associated with office hours may influence the decision to deliver by caesarean section. Further detailed investigation of the “office hours effect” in delivery care is necessary and could lead to improvements in care systems. Funding The authors received no direct funding for this study.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Hoxha

Lama²,

Bunjaku³

et al. 2022

Res Health Serv Reg

Self Cite

View full text Add to dashboard Cite

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“…Cesarean sections (CS) are an important procedure for improving long-term health outcomes in high-risk births, but there is concern that CS rates continue to rise globally and are widely used in low-risk pregnancies (Hoxha et al, 2021), possibly due to higher payment for CS than for vaginal births. Using data from a national survey of women who gave birth in 2011 to 2012, Morris et al (2017) report that the probability of delivery by CS is up to twice higher in FPs than in NFPs, controlling for maternal attributes and other factors-results consistent with an earlier study of CS versus vaginal delivery by Gruber and Owings (1996).…”

Section: Quality: Structure Several Papers Have Used Cardiovascularmentioning

confidence: 99%

Relative Productivity of For-Profit Hospitals: A Big or a Little Deal?

Sloan

Valdmanis

2023

Med Care Res Rev

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This study asks: Does the empirical evidence support the conclusion that for-profit (FP) hospitals are more productive or efficient than private not-for-profit (NFP) hospitals or non-federal public (PUB) hospitals? Alternative theories of NFP behavior are described. Our review of individual empirical hospital studies of quality, service mix, community benefit, and cost/efficiency in the United States published since 2000 indicates that no systematic difference exists in cost/efficiency, provision of uncompensated care, and quality of care. But FPs are more likely to provide profitable services, higher service intensity, have lower shares of uninsured and Medicaid patients, and are more responsive to external financial incentives. That FP hospitals are not more efficient runs counter to property rights theory, but their relative responsiveness to financial incentives supports it. There is little evidence that FP market presence changes NFP behaviors. Observed differences between FP and NFP hospitals are mostly a “little deal.”

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“…τ 2 with values of 0.04, 0.16, and 0.36 represent low, moderate, and high heterogeneity between studies. 26 For similar studies, [27][28][29][30] we have used τ 2 as it is more informative due to the high precision of included studies. For groups with only one study, we did not perform meta-analysis but only presented them in the forest plots.…”

Section: Midwife Present In the Institutionmentioning

confidence: 99%

Systematic review and meta‐analysis examining the effects of midwife care on cesarean birth

Hoxha,

Grezda,

Udutha

et al. 2023

Birth

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BackgroundThe increasing number of unnecessary cesarean births is a cause for concern and may be addressed by increasing access to midwifery care. The objective of this review was to assess the effect of midwifery care on the likelihood of cesarean births.MethodsWe searched five databases from the beginning of records through May 2020. We included observational studies that reported odds ratios or data allowing the calculation of odds ratios of cesarean birth for births with and without midwife involvement in care or presence at the institution. Standard inverse‐variance random‐effects meta‐analysis was used to generate overall odds ratios (ORs).ResultsWe observed a significantly lower likelihood of cesarean birth in midwife‐led care, midwife‐attended births, among those who received instruction pre‐birth from midwives, and within institutions with a midwifery presence.ConclusionsCare from midwives reduces the likelihood of cesarean birth in all the analyses, perhaps due to their greater preference and skill for physiologic births. Increased use of midwives in maternal care can reduce cesarean births and should be further researched and implemented broadly, potentially as the default modality in maternal care.

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Caesarean sections in teaching hospitals: systematic review and meta-analysis of hospitals in 22 countries

Cited by 6 publications

References 72 publications

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

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

Relative Productivity of For-Profit Hospitals: A Big or a Little Deal?

Systematic review and meta‐analysis examining the effects of midwife care on cesarean birth

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