Nonclinical parameters affecting primary cesarean rates in the United States.

MedStar author(s):
Citation: American Journal of Perinatology. 31(3):213-22, 2014 Mar.PMID: 23670226Institution: MedStar Washington Hospital CenterDepartment: Obstetrics and Gynecology, Maternal-Fetal MedicineForm of publication: Journal ArticleMedline article type(s): Journal Article | Multicenter Study | Observational Study | Research Support, N.I.H., IntramuralSubject headings: *Cesarean Section/sn [Statistics & Numerical Data] | Confounding Factors (Epidemiology) | Delivery, Obstetric/sn [Statistics & Numerical Data] | Female | Humans | Male | Multivariate Analysis | Obstetrics | Pregnancy | Retrospective Studies | Risk Factors | United StatesISSN:
  • 0735-1631
Name of journal: American journal of perinatologyAbstract: 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.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).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.All authors: Bailit JL, Branch DW, Burkman R, Consortium on Safe Labor, Gonzalez-Quintero VH, Gregory KD, Haberman S, Hibbard JU, Hoffman MK, Kominiarek M, Landy HJ, Lu L, Ramirez MM, Saraf S, Van Veldhuisen P, Von Gruenigen V, Zhang JDigital Object Identifier: Date added to catalog: 2014-10-01
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Journal Article MedStar Authors Catalog Article Available 23670226

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.

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).

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.

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