October 28, 2014 — Variation in cesarean section rates among hospitals might have more to do with hospital culture and policies than factors related to patient risk, according to a study published last week in PLOS Medicine, FierceHealthcare reports.
For the study, University of Minnesota researchers examined data from almost 1.5 million births in 1,373 hospitals (Budryk, FierceHealthcare, 10/23). The hospitals spanned 46 states.
Overall, the study found that C-sections were the most common inpatient surgery in the U.S. in 2011. The procedure was used in one-third of all deliveries in the U.S. that year, with a total of 1.3 million infants delivered via C-section.
The study also showed that C-section rates varied widely between hospitals, ranging from 19% to 48%. Rates among women categorized as lower-risk ranged from 8% to 32% between hospitals, while rates among higher-risk women ranged from 56% to 92%, the study found (HealthDay/Philadelphia Inquirer, 10/24).
Risk Factors Do Not Account for Variation
According to the researchers, the variation in C-section rates between hospitals "did not fall when [they] adjusted for socioeconomic factors, hospital characteristics or patient diagnoses" (FierceHealthcare, 10/23). The variation also "was not driven by differences in maternal diagnoses or pregnancy complexity," the researchers wrote, adding, "This means there was significantly higher variation in hospital rates than would be expected based on women's health conditions" (HealthDay/Philadelphia Inquirer, 10/24).
The researchers added that the "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" (FierceHealthcare, 10/23).
University of Minnesota's Katy Kozhimannil, the study's lead author, added in a statement, "Women deserve evidence-based, consistent, high-quality maternity care, regardless of the hospital where they give birth, and these results indicate that we have a long way to go toward reaching this goal in the U.S." (HealthDay/Philadelphia Inquirer, 10/24).