Shoshana Haberman1, Sumit Saraf1, Jun Zhang2, Helain J Landy3, D W Branch4, Ronald Burkman5, Kimberly D Gregory6, Mildred M Ramirez7, Jennifer L Bailit8, Victor H Gonzalez-Quintero9, Judith U Hibbard10, Matthew K Hoffman11, Michelle Kominiarek10, Li Lu12, Paul Van Veldhuisen12, Vivian Von Gruenigen13. 1. Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York. 2. MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China. 3. Department of Obstetrics and Gynecology, Georgetown University Hospital, MedStar Health, Washington, District of Columbia. 4. Intermountain HealthCare and University of Utah, Salt Lake City, Utah. 5. Baystate Medical Center, Springfield, Massachusetts. 6. Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California. 7. Department of Obstetrics and Gynecology Texas Children's Hospital, University of Texas Health Science Center at Houston, Houston, Texas. 8. MetroHealth Medical Center, Cleveland, Ohio. 9. Department of Obstetrics and Gynecology, University of Miami, Miami, Florida. 10. Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, Illinois. 11. Christiana Care Health System, Wilmington, Delaware. 12. The EMMES Corporation, Rockville, Maryland. 13. Summa Health System, Akron City Hospital, Akron, Ohio.
Abstract
OBJECTIVE: Cesarean is the single most common operation in United States and has reached epidemic proportions in recent decades. Our objective was to study the effect of nonclinical parameters on primary cesarean rates in a large contemporary population. STUDY DESIGN: We designed a retrospective multicenter study using data obtained from electronic medical records from 19 U.S. hospitals between 2005 and 2007 (Consortium on Safe Labor Database), which included 145,764 term, singleton, nonanomalous, vertex, live births that included labor. The impact of nonclinical parameters (patient and provider characteristics, time of delivery, institutional policies, and insurance type) was investigated using modified Poisson regression methodology and classification and regression tree analysis. RESULTS: There were 125,517 vaginal and 20,247 cesarean deliveries. Using the multivariable model, the nonclinical parameters with statistical significance for primary cesarean were delivery during evening hours, a male provider, public insurance, and nonwhite race (p < 0.001). CONCLUSIONS: Cesarean rates are associated with several nonclinical factors. Further investigation into these factors might help to develop strategies to reduce their influence and hence the rates of cesarean. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
OBJECTIVE: Cesarean is the single most common operation in United States and has reached epidemic proportions in recent decades. Our objective was to study the effect of nonclinical parameters on primary cesarean rates in a large contemporary population. STUDY DESIGN: We designed a retrospective multicenter study using data obtained from electronic medical records from 19 U.S. hospitals between 2005 and 2007 (Consortium on Safe Labor Database), which included 145,764 term, singleton, nonanomalous, vertex, live births that included labor. The impact of nonclinical parameters (patient and provider characteristics, time of delivery, institutional policies, and insurance type) was investigated using modified Poisson regression methodology and classification and regression tree analysis. RESULTS: There were 125,517 vaginal and 20,247 cesarean deliveries. Using the multivariable model, the nonclinical parameters with statistical significance for primary cesarean were delivery during evening hours, a male provider, public insurance, and nonwhite race (p < 0.001). CONCLUSIONS: Cesarean rates are associated with several nonclinical factors. Further investigation into these factors might help to develop strategies to reduce their influence and hence the rates of cesarean. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Authors: Andrea E Cassidy-Bushrow; Ganesa Wegienka; Suzanne Havstad; Albert M Levin; Susan V Lynch; Dennis R Ownby; Andrew G Rundle; Kimberley J Woodcroft; Edward M Zoratti; Christine Cole Johnson Journal: Ethn Dis Date: 2016-01-21 Impact factor: 1.847