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

Clapp, Mark A.; James, Kaitlyn; Melamed, Alexander; Ecker, J.L.; Kaimal, Anjali J

doi:10.1038/jp.2017.173

Cited by 10 publications

(16 citation statements)

References 18 publications

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“…29 The NRD has been used previously to explore associations between maternal health and delivery outcomes as they relate to hospital characteristics. 30,31 Data analyses were performed between August 2019 and May 2020. This study followed the Strengthening and Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline for cross-sectional studies.…”

Section: Methodsmentioning

confidence: 99%

“…[32][33][34] We limited our analytic cohort to women at low risk for a cesarean delivery. 35 We excluded hospitals that did not perform cesarean deliveries in order to exclude birthing facilities that do not have the capability of providing cesarean deliveries 30 and hospitals that performed less than 100 deliveries per year to avoid unstable estimates, an approach used in prior studies. 1,2,30,34,35…”

Section: Identification Of Patientsmentioning

confidence: 99%

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Evaluation of Hospital Cesarean Delivery–Related Profits and Rates in the United States

et al. 2021

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IMPORTANCE A high cesarean delivery rate in US hospitals indicates the potential overuse of this procedure; however, underlying causes of the excessive use of cesarean procedures in the US have not been fully understood. OBJECTIVE To investigate the association between the probability of cesarean delivery at the patient-level and profit per procedure from cesarean deliveries. DESIGN, SETTING, AND PARTICIPANTS This observational, cross-sectional study used a nationally representative sample of hospital discharge data from women at low risk for cesarean birth who delivered newborns between 2010 and 2014 in the US. Data were gathered from the Nationwide Readmissions Database from the Healthcare Cost and Utilization Project, compiled by the Agency for Healthcare Research and Quality. Data cleaning and analyses were conducted between August 2019 and May 2020. EXPOSURES Hospital-level median value of profits from cesarean deliveries, defined as the difference between the charge and the cost for cesarean delivery calculated for each hospital. MAIN OUTCOMES AND MEASURES Our primary outcome was the individual-level probability of undergoing a cesarean delivery. We examined the association with the hospital-level median value of profits per procedure for cesarean delivery (defined as the difference between the charge and the cost for cesarean delivery) using hierarchical regression models adjusted for patient and hospital characteristics and year-fixed effects. RESULTS A total of 13 215 853 deliveries were included in our analyses (mean [SE] age, 27.4 [0] years), of which 2 202 632 (16.7%) were cesarean deliveries. After adjusting for potential confounders, pregnant women were more likely to have a cesarean birth when they delivered at hospitals with higher profits per procedure from cesarean deliveries. Women cared for at hospitals with the highest (adjusted odds ratio, 1.08; 95% CI, 1.02-1.14; P = .005) and second-highest profit quartiles (adjusted odds ratio, 1.07; 95% CI, 1.02-1.13; P = .007) had higher probabilities of a cesarean delivery compared with those cared for at hospitals in the lowest profit quartile. CONCLUSIONS AND RELEVANCE In this cross-sectional study of US nationally representative hospital discharge data, hospitals with higher profits per cesarean procedure were associated with an increased probability of delivering newborns through cesarean birth. These findings highlight the potential influence financial incentives play in determining a high cesarean delivery rate in the US.

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Section: Methodsmentioning

confidence: 99%

Section: Identification Of Patientsmentioning

confidence: 99%

Evaluation of Hospital Cesarean Delivery–Related Profits and Rates in the United States

et al. 2021

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“…In a retrospective study of 845.056 low‐risk patients, Clapp et al . confirmed that hospital volume was not associated with the odds of cesarean delivery 15 . However, a recent report by Declercq et al .…”

Section: Discussionmentioning

confidence: 90%

“…In a retrospective study of 845.056 low-risk patients, Clapp et al confirmed that hospital volume was not associated with the odds of cesarean delivery. 15 However, a recent report by Declercq et al suggests that the rise of cesarean rates in industrialized countries might have come to an end. 16 A Lancet editorial commented on the latest CDC reports that one of the world's wealthiest countries, with the highest per-capita healthcare spending globally, has backslid in terms of maternal mortality.…”

Section: Discussionmentioning

confidence: 99%

Analysis of nationwide reflection of rising cesarean section rate in neonatal outcomes of Hungary

Póka

Török

2020

J of Obstet and Gynaecol

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Aim: The authors investigated the effect of rising cesarean rates on maternal and perinatal mortality and in neonatal morbidity in Hungary. Methods: The authors searched the validated Hungarian National Health database of neonatal discharge records for ICD-10 codes: P0590 (growth restriction); P2010 (fetal hypoxia in labor); P2090 (intrauterine hypoxia); P2200 (respiratory distress syndrome); P2390 (congenital pneumonia); P2400 (meconium aspiration); P2850 (respiratory insufficiency); P3990 (neonatal infection); P9130 (cerebral irritability) and P9141 (cerebral depression) collected between 2006 and 2015. County-specific number of deliveries, perinatal deaths, and data on the route of delivery from the national database were also collected. Controlling for regional disparities with Human Development Index was also performed. Logistic regression analysis was performed to identify determinants of early neonatal mortality. Results: While cesarean section-rate rose from 28.6% to 38.2% perinatal mortality stayed within the range between 7.8‰ and 6.1‰. Early (0-6 days) neonatal mortality (NMR) of the whole country in 2006 was 2.8‰ and showed a significant decrease over the years to reach 1.7‰ in 2015. The rate of most neonatal morbidities decreased significantly. Controlled regression analysis proved that cesarean rates negatively influenced neonatal mortality rates. Conclusion: The rise of the cesarean section rate in Hungary between 2006 and 2015 was associated with a detectable reduction of perinatal mortality and morbidity; however, the proportion of improvement in neonatal morbidity is far less than the increment in cesarean rate.

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“…The literature on the impact of delivery volume on Original Research cesarean delivery rates overall has been mixed. 17,18,19…”

Section: Resultsmentioning

confidence: 99%

Institutional prevalence of class III obesity modifies risk of adverse obstetrical outcomes

Eriksen

Souter

Napolitano

et al. 2020

American Journal of Obstetrics & Gynecology MFM

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BACKGROUND: Women with prepregnancy class III obesity (body mass index 40 kg/m 2 ) are at an increased risk of perinatal complications and adverse obstetrical outcomes. Estimates of the magnitude of risk that these women face vary widely, which may reflect differences in institutional experience caring for women with obesity. OBJECTIVE: We sought to characterize the relationship between institutional prevalence of prepregnancy class III obesity and the risk of adverse perinatal outcomes among these women, hypothesizing that higher-prevalence institutions would have lower rates of adverse maternal and perinatal outcomes among this population. STUDY DESIGN: We conducted a retrospective cohort study using chart-abstracted data on births in Washington state from Jan. 1, 2012, to Dec. 31, 2017. The analysis was restricted to hospitals that delivered at least 1 patient per month with prepregnancy class III obesity. Institutional prevalence of prepregnancy class III obesity was calculated, and hospitals were classified as either high or low prevalence. We included nulliparous women with vertex-presenting singleton pregnancies at 37 weeks of gestation. We excluded births with missing initial body mass index. The primary outcome was the incidence of cesarean delivery. Secondary outcomes were induction of labor, postpartum complications, postpartum readmission, and neonatal intensive care unit admissions. We compared outcomes between women with prepregnancy class III and all obesity at

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

Abstract: Hospital delivery volume is not an independent predictor of cesarean delivery in this population.

Cited by 10 publications

References 18 publications

Evaluation of Hospital Cesarean Delivery–Related Profits and Rates in the United States

Evaluation of Hospital Cesarean Delivery–Related Profits and Rates in the United States

Analysis of nationwide reflection of rising cesarean section rate in neonatal outcomes of Hungary

Institutional prevalence of class III obesity modifies risk of adverse obstetrical outcomes

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