Abstract
BackgroundCaesarean delivery (CD) rates have been frequently used as quality measures for maternity service comparisons. More recently, primary CD rates (CD in women without previous CD) or CD rates within selected categories such as nulliparous, term, cephalic singleton deliveries (NTCS) have been used. The objective of this study is to determine the extent to which risk adjustment for clinical and socio-demographic variables is needed for inter-hospital comparisons of CD rates in women without previous CD and in NTCS deliveries.MethodsHospital discharge records of women who delivered in Emilia-Romagna Region (Italy) from January, 2007 to June 2009 and in Tuscany Region for year 2009 were linked with birth certificates. Adjusted RRs of CD in women without a previous Caesarean and NTCS were estimated using Poisson regression. Percentage differences in RR before and after adjustment were calculated and hospital rankings, based on crude and adjusted RRs, were examined.ResultsAdjusted RR differed substantially from crude RR in women without a previous Caesarean and only marginally in NTCS group. Hospital ranking was markedly affected by adjustment in women without a previous CD, but less in NTCS.ConclusionRisk adjustment is warranted for inter-hospital comparisons of primary CD rates but not for NTCS CD rates. Crude NTCS CD rates are a reliable estimate of adjusted NTCS CD.
Highlights
The Caesarean delivery (CD) rate continues to rise in many countries worldwide even though this increase does not appear to be associated with improvement in maternal and perinatal mortality or morbidity [1]
The use of unadjusted CD rates has been questioned and case-mix adjustment has been recommended for audit and inter-hospital comparisons of overall and primary CD rates [5,6,8,15,16,17], but evidence about the need to use adjusted models for comparison of NTCS CD rates is limited [9,14]
In the Emilia Romagna Region, in 24 hospitals there was a total of 98,913 deliveries, of which 87,849 had no previous CD and 46,179 were NTCS
Summary
The Caesarean delivery (CD) rate continues to rise in many countries worldwide even though this increase does not appear to be associated with improvement in maternal and perinatal mortality or morbidity [1]. The most frequently used quality indicator to evaluate and compare maternal services is the overall CD rate [4,5,6,7] Recently this measure has been questioned and other measures have been introduced for audit activities and inter-hospital comparison [8]. Based on evidence suggesting that non-vertex and multiple births may have better outcomes with CD [12,13], some authors omitted these categories from the calculation of CD rates and examined only nulliparous, term, cephalic singleton deliveries (NTCS) [4,9,11,13,14] This group accounts for a large proportion of CD and includes potentially lower-risk pregnancies [14]. The objective of this study is to determine the extent to which risk adjustment for clinical and socio-demographic variables is needed for inter-hospital comparisons of CD rates in women without previous CD and in NTCS deliveries
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
