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Inter-institutional Variation in Use of Caesarean Delivery for Labour Dystocia
- Source :
- Journal of Obstetrics and Gynaecology Canada. 39:988-995
- Publication Year :
- 2017
- Publisher :
- Elsevier BV, 2017.
-
Abstract
- Objective To establish the degree of variation across hospitals in the use of Caesarean delivery for the indication of labour dystocia before and after accounting for maternal, fetal, and hospital characteristics. Methods This study was a retrospective, population-based cohort study of nulliparous women delivering term singletons in cephalic position following labour. Delivery visits were extracted from three provincial perinatal registries in the Canadian provinces of Ontario, Alberta, and British Columbia, from 2008-2012. Crude hospital-specific rates of Caesarean delivery for labour dystocia were reported, and these rates were then stabilized to account for hospitals with low delivery volumes. Rates were then adjusted for maternal, fetal, and hospital characteristics using hierarchical logistic regression. Results Among 403 205 women delivering at 170 hospitals, the overall Caesarean delivery rate was 21.0%, and the rate of Caesarean delivery for labour dystocia was 12.7%, indicating that 60% of all Caesarean deliveries were performed in part for this indication. The middle 95% of hospitals had Caesarean delivery rates for labour dystocia ranging from 4.5% to 24.7%. Differences in maternal case mix and hospital characteristics explained only a small proportion of this variation (95% central range 6.3%–21.7%). Conclusion Considerable inter-hospital variation in rates of Caesarean delivery for labour dystocia remained after accounting for differences in maternal and hospital factors. Reporting systems that monitor variation in inter-institutional rates should incorporate stabilization and adjustment for case-mix differences and consider indication-specific rates of Caesarean delivery to more fairly compare hospital performance and better target interventions to reduce Caesarean delivery for specific indications.
- Subjects :
- Adult
Canada
Pediatrics
medicine.medical_specialty
Population
Caesarean delivery
Psychological intervention
Logistic regression
Hospital performance
Cohort Studies
Young Adult
03 medical and health sciences
0302 clinical medicine
Case mix index
Pregnancy
medicine
Humans
Maternal Health Services
Registries
030212 general & internal medicine
education
reproductive and urinary physiology
Retrospective Studies
education.field_of_study
030219 obstetrics & reproductive medicine
Cesarean Section
Obstetrics
business.industry
Obstetrics and Gynecology
Delivery, Obstetric
Dystocia
female genital diseases and pregnancy complications
3. Good health
Parity
Female
business
Cohort study
Subjects
Details
- ISSN :
- 17012163
- Volume :
- 39
- Database :
- OpenAIRE
- Journal :
- Journal of Obstetrics and Gynaecology Canada
- Accession number :
- edsair.doi.dedup.....6c984cc3591367bc02eba5e0c29b3312