Transactions of the Sixty-Seventh Annual Meeting of the Pacific Coast Obstetrical and Gynecological SocietyVariation in elective primary cesarean delivery by patient and hospital factors☆,☆☆
Section snippets
Methods
The study population consisted of all patients who were delivered in 1995 in the State of California, as reported to the California Office of Statewide Health Planning and Development. Demographic characteristics (age ≥35 years, age <35 years, race/ethnicity, payor type: government, staff model health maintenance organization (HMO), private, other), and delivery hospital were identified from California Office of Statewide Health Planning and Development data. An American Hospital Association
Results
The final study population is described in Fig 1. Of a total of 463,196 deliveries, 443,532 (95.75%) women labored, and 19,664 (4.25%) had an elective primary cesarean delivery. The total number of hospitals involved was 288, and the mean number of deliveries per hospital was 1838 ± 1367 (Table I). Per hospital, the mean elective primary cesarean delivery rate was 4.08% ± 1.61%. Some variation in median elective primary cesarean delivery rates existed by hospital
Comment
The purpose of our study was to examine the variation in elective primary cesarean delivery by patient demographic and hospital organizational factors. We found that there was variation in the likelihood of elective primary cesarean delivery for different subcategories of patients and that different clinical categories had different risk factors or “drivers.” Our study is different from previous studies in several ways. First, we focused on elective primary procedures. Although considerable
Acknowledgements
We thank Jeff Gornbein, PhD, from the Department of Biostatistics, University of California School of Public Health, for his expertise and advise regarding the use of recursive partitioning algorithms.
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2013, American Journal of Obstetrics and GynecologyCitation Excerpt :Nonetheless, given that our results were robust to adjusting for available clinical factors, the possibility exists that trends may be due to changes in physician practices or patient preferences. Indeed, nonclinical factors have been shown to contribute to variation in the primary cesarean delivery rate.22-26 Among the many nonclinical factors to consider would be the release of relevant guidelines or important documents that might affect primary cesarean delivery rates.
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Reprint requests: Kimberly D. Gregory, MD, Cedars Sinai Medical Center, Department of Obstetrics and Gynecology, 8700 Beverly Blvd, Suite 160 West, Los Angeles, CA 90048.
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Editors ’ note: This manuscript was revised after these discussions were presented.