1015 Cesarean delivery rates by hospital type among nulliparous and multiparous patients

Abstract

To investigate cesarean delivery by hospital type in California. We performed a retrospective study of singleton, non-anomalous, term deliveries in California. We excluded hospitals with <50 deliveries per year and missing hospital information. We separated hospitals by volume based on previously published categories: lowest volume (<1200 deliveries/year), medium volume (1200-2399 deliveries/year), and highest volume (≥2400 deliveries/year). We also evaluated rural versus urban and non-teaching versus teaching hospitals. We looked at all patients and separately those who were nulliparous and multiparous patients with and without prior cesarean. We analyzed data with multivariable logistic regression to control for confounders and measure the odds of cesarean delivery between hospital categories. In a total of 1,406,865 women, 476,369 (34%) women had cesarean deliveries. After controlling for race, age, BMI, education, insurance, parity, and prior cesarean, rates of cesarean delivery were higher in low volume hospitals (aOR: 1.07; 95% CI: 1.05-1.09) and medium volume hospitals (aOR: 1.03; 95% CI: 1.02-1.04) as compared to high volume hospitals (Table 1). Rural hospitals had higher rates of cesarean delivery (aOR: 1.07; 95% CI: 1.04-1.09) as compared to urban hospitals and community hospitals have higher odds of cesarean deliveries (aOR: 1.31; 95% CI: 1.28-1.33) as compared to academic hospitals. Among nulliparous patients, rural and non-teaching hospitals had higher rates of cesarean deliveries. Multiparous patients without prior cesarean had higher rates of cesarean delivery at lower volume and non-teaching hospitals. Multiparous patients with prior cesarean had higher rates of cesarean delivery at lower volume, rural, and non-teaching hospitals (Table 1). After controlling for confounders, cesarean delivery rates were higher at lower volume, rural and community hospitals as compared to high volume, urban and academic centers including those by parity and prior cesarean history. This necessitates further investigation into the difference in practice by hospital type.