skip to main content
Language:
Search Limited to: Search Limited to: Resource type Show Results with: Show Results with: Search type Index

Maternal clinical diagnoses and hospital variation in the risk of cesarean delivery: analyses of a National US Hospital Discharge Database

PLoS medicine, 2014-10, Vol.11 (10), p.e1001745-e1001745 [Peer Reviewed Journal]

COPYRIGHT 2014 Public Library of Science ;COPYRIGHT 2014 Public Library of Science ;2014 Kozhimannil et al 2014 Kozhimannil et al ;2014 Public Library of Science. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited: Kozhimannil KB, Arcaya MC, Subramanian SV (2014) Maternal Clinical Diagnoses and Hospital Variation in the Risk of Cesarean Delivery: Analyses of a National US Hospital Discharge Database. PLoS Med 11(10): e1001745. doi:10.1371/journal.pmed.1001745 ;ISSN: 1549-1676 ;ISSN: 1549-1277 ;EISSN: 1549-1676 ;DOI: 10.1371/journal.pmed.1001745 ;PMID: 25333943

Full text available

Citations Cited by
  • Title:
    Maternal clinical diagnoses and hospital variation in the risk of cesarean delivery: analyses of a National US Hospital Discharge Database
  • Author: Kozhimannil, Katy B ; Arcaya, Mariana C ; Subramanian, S V
  • Smith, Gordon C.
  • Subjects: Age ; Babies ; Cesarean section ; Cesarean Section - statistics & numerical data ; Childbirth & labor ; Confidence intervals ; Databases, Factual ; Delivery, Obstetric - statistics & numerical data ; Demographic aspects ; Diabetes ; Ethnicity ; Female ; Hospitals - statistics & numerical data ; Humans ; Hypertension ; Medical research ; Medicine and Health Sciences ; Obstetric Labor Complications - diagnosis ; Obstetric Labor Complications - epidemiology ; Obstetric Labor Complications - surgery ; Obstetrics ; Pregnancy ; Risk Factors ; Studies ; Womens health
  • Is Part Of: PLoS medicine, 2014-10, Vol.11 (10), p.e1001745-e1001745
  • Description: Cesarean delivery is the most common inpatient surgery in the United States, where 1.3 million cesarean sections occur annually, and rates vary widely by hospital. Identifying sources of variation in cesarean use is crucial to improving the consistency and quality of obstetric care. We used hospital discharge records to examine the extent to which variability in the likelihood of cesarean section across US hospitals was attributable to individual women's clinical diagnoses. Using data from the 2009 and 2010 Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project--a 20% sample of US hospitals--we analyzed data for 1,475,457 births in 1,373 hospitals. We fitted multilevel logistic regression models (patients nested in hospitals). The outcome was cesarean (versus vaginal) delivery. Covariates included diagnosis of diabetes in pregnancy, hypertension in pregnancy, hemorrhage during pregnancy or placental complications, fetal distress, and fetal disproportion or obstructed labor; maternal age, race/ethnicity, and insurance status; and hospital size and location/teaching status. The cesarean section prevalence was 22.0% (95% confidence interval 22.0% to 22.1%) among women with no prior cesareans. In unadjusted models, the between-hospital variation in the individual risk of primary cesarean section was 0.14 (95% credible interval 0.12 to 0.15). The difference in the probability of having a cesarean delivery between hospitals was 25 percentage points. Hospital variability did not decrease after adjusting for patient diagnoses, socio-demographics, and hospital characteristics (0.16 [95% credible interval 0.14 to 0.18]). A limitation is that these data, while nationally representative, did not contain information on parity or gestational age. Variability across hospitals in the individual risk of cesarean section is not decreased by accounting for differences in maternal diagnoses. These findings highlight the need for more comprehensive or linked data including parity and gestational age as well as examination of other factors-such as hospital policies, practices, and culture--in determining cesarean section use. Please see later in the article for the Editors' Summary.
  • Publisher: United States: Public Library of Science
  • Language: English
  • Identifier: ISSN: 1549-1676
    ISSN: 1549-1277
    EISSN: 1549-1676
    DOI: 10.1371/journal.pmed.1001745
    PMID: 25333943
  • Source: Public Library of Science (PLoS) Journals Open Access
    PubMed (Medline)
    AUTh Library subscriptions: ProQuest Central
    GFMER Free Medical Journals
    MEDLINE
    DOAJ Directory of Open Access Journals
Back to results list
INSPIRE LIBRARY - TON DUC THANG UNIVERSITY (84-028) 37 755 057 Feedback
19 Nguyen Huu Tho St. Dist.7, HCM thuvien@tdtu.edu.vn

Copyright © 2017 INSPIRE LIBRARY - TON DUC THANG UNIVERSITY

Searching Remote Databases, Please Wait