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

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Abstract

OBJECTIVE:

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

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