Sandro Gerli1, Alessandro Favilli1, David Franchini2, Marcello De Giorgi2, Paola Casucci3, Fabio Parazzini4,5. 1. a Department of Obstetrics and Gynecology , University of Perugia , S. Andrea delle Fratte , Perugia , Italy. 2. b S.C.A.R.L , Umbria Digitale , Perugia , Italy. 3. c Regione Umbria , Direzione Regionale Salute , Perugia , Italy. 4. d Dipartimento Materno Infantile, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Università di Milano , Milan , Italy. 5. e Dipartimento di Scienze Cliniche e di Comunità , Universita' di Milano , Milan , Italy.
Abstract
OBJECTIVE: To assess if maternal risk profile and Hospital assistential levels were able to influence the inter-Hospitals comparison in the class 1 and 3 of the "The Ten Group Classification System" (TGCS). METHODS: A population-based analysis using data from Institutional data-base of an Italian Region was carried out. The 11 maternity wards were divided into two categories: second-level hospitals (SLH), and first-level hospitals (FLH). The recorded deliveries were classified according to the TGCS. To analyze if different maternal characteristics and the hospitals assistential level could influence the cesarean section (CS) risk, a multivariate analysis was done considering separately women in the TGCS class 1 and 3. RESULTS: From January 2011 to December 2013 were recorded 19,987 deliveries. Of those 7,693 were in the TGCS class 1 and 4,919 in the class 3. The CS rates were 20.8% and 14.7% in class 1 (p < 0.0001) and 6.9% and 5.3% (p < 0.0230) in class 3, respectively in the FLH and SLH. The multivariate logistic regression showed that the FLH, older maternal age and gestational diabetes were independent risk factors for CS in groups 1 and 3. Obesity and gestational hypertension were also independent risk factors for group 1. CONCLUSIONS: TGCS is a useful tool to analyze the incidence of CS in a single center but in comparing different Hospitals, maternal characteristics and different assistential levels should be considered as potential bias.
OBJECTIVE: To assess if maternal risk profile and Hospital assistential levels were able to influence the inter-Hospitals comparison in the class 1 and 3 of the "The Ten Group Classification System" (TGCS). METHODS: A population-based analysis using data from Institutional data-base of an Italian Region was carried out. The 11 maternity wards were divided into two categories: second-level hospitals (SLH), and first-level hospitals (FLH). The recorded deliveries were classified according to the TGCS. To analyze if different maternal characteristics and the hospitals assistential level could influence the cesarean section (CS) risk, a multivariate analysis was done considering separately women in the TGCS class 1 and 3. RESULTS: From January 2011 to December 2013 were recorded 19,987 deliveries. Of those 7,693 were in the TGCS class 1 and 4,919 in the class 3. The CS rates were 20.8% and 14.7% in class 1 (p < 0.0001) and 6.9% and 5.3% (p < 0.0230) in class 3, respectively in the FLH and SLH. The multivariate logistic regression showed that the FLH, older maternal age and gestational diabetes were independent risk factors for CS in groups 1 and 3. Obesity and gestational hypertension were also independent risk factors for group 1. CONCLUSIONS: TGCS is a useful tool to analyze the incidence of CS in a single center but in comparing different Hospitals, maternal characteristics and different assistential levels should be considered as potential bias.
Authors: Stefania Triunfo; Sergio Ferrazzani; Gaetano Draisci; Bruno Antonio Zanfini; Giovanni Scambia; Antonio Lanzone Journal: BMJ Open Date: 2018-04-07 Impact factor: 2.692
Authors: Giulia M Muraca; K S Joseph; Neda Razaz; Linnea V Ladfors; Sarka Lisonkova; Olof Stephansson Journal: PLoS Med Date: 2022-08-01 Impact factor: 11.613