MedicalResearch.com Interview with:
Kamila Mistry, PhD MPH
MedicalResearch.com: What is the background for this study?
Response: Although the overall cesarean section (C-section) rate in the United States has declined slightly in recent years, nearly a third of all births continue to be delivered by C-section—higher than in many other industrialized countries. A number of medical as well as nonmedical factors may contribute to high C-section rates.
C-section is the most common surgical procedure performed in the United States. This operation carries additional risks compared with vaginal delivery, such as infection and postoperative pain. A C-section also may make it more difficult for the mother to establish breastfeeding and may complicate subsequent pregnancies.
Consensus guidelines from the American Congress of Obstetricians and Gynecologists and other national efforts to improve perinatal care have shown promise in reducing nonmedically indicated C-sections. However, recent research has found wide variation in hospital C-section rates even for low-risk deliveries.
MedicalResearch.com: What are the main findings?
• In 2013, there were 3.5 million total and 2.5 million low-risk deliveries across 2,719 hospitals in 43 States and the District of Columbia. These hospitals account for over 95 percent of hospital deliveries nationally. Among all deliveries, the rate of C-section was 33.1 per 100—twice the low-risk C-section rate (16.2 per 100 low-risk deliveries).
• The majority of all C-sections (65 percent) had a medical indication listed on the record and so were not considered to be low-risk. Among deliveries with a medical indication, the C-section rate was 76.1 per 100.
• Among hospitals with 1,000 or more deliveries—which accounted for over 80 percent of all deliveries and C-sections—the minimum and maximum low-risk C-section rate differed ten-fold (from 4.6 to 46.9 per 100 low-risk deliveries). In contrast, the total C-section rate differed only four-fold (from 15.4 to 63.5 per 100 total deliveries).
• The mean low-risk C-section rate was higher among private for-profit hospitals, hospitals in large metropolitan areas, and hospitals in the Northeast and South, compared with other hospitals. The total C-section rate showed a similar pattern by region but did not differ across other hospital characteristics.
MedicalResearch.com: What should readers take away from your report?
Response: This results show differing patterns or variation in C-section rates across hospitals, particularly for low-risk pregnancies for which the procedure is not medically indicated. This variation raises questions about the quality of maternal care and has important implications for maternal and neonatal outcomes and costs for hospitals, delivery systems, and insurers.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Given potential risks and associated costs—in 2011, the average cost of a hospital stay resulting in C-section was over 50 percent higher than a stay involving vaginal delivery—reducing the C-section delivery rate continues to be an important focus for future research and also public health efforts nationwide, particularly for low-risk deliveries with no medical indication for the procedure.
Future research should focus better on understanding potential drivers of variation and also evaluate the effectiveness of promising practice and policy-level interventions that are used to reduce variation in the low-risk C-section rate.
MedicalResearch.com: Is there anything else you would like to add?
Response: This Healthcare Cost and Utilization Project (HCUP) Statistical Brief presents information on variation in the rate of total and low-risk C-sections across U.S. hospitals in 2013. It expands on previous studies in two significant ways—by using the State Inpatient Databases (SID) rather than the Nationwide Inpatient Sample (NIS) to allow for a more accurate hospital-level statistics and by using a new definition of low-risk C-section developed by the Society of Maternal-Fetal Medicine in 2016, which is more clinically comprehensive than other prior definitions.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
September 2016 Variation in the Rate of Cesarean Section Across U.S. Hospitals, 2013 Kamila Mistry, Ph.D., M.P.H., Kathryn R. Fingar, Ph.D., M.P.H., and Anne Elixhauser, Ph.D.
AHRQ STATISTICAL BRIEF #211
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