Risk factors and between-hospital variation of caesarean section in Denmark: a cohort study

Sonja Wehberg*, Rikke Guldberg, Kim Oren Gradel, Ulrik Schiøler Kesmodel, Lis Munk, Charlotte Brix Andersson, Line Riis Jølving, Jan Nielsen, Bente Mertz Nørgård

*Kontaktforfatter for dette arbejde

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Resumé

OBJECTIVES: The aim of this study was to estimate the effects of risk factors on elective and emergency caesarean section (CS) and to estimate the between-hospital variation of risk-adjusted CS proportions.

DESIGN: Historical registry-based cohort study.

SETTINGS AND PARTICIPANTS: The study was based on all singleton deliveries in hospital units in Denmark from January 2009 to December 2012. A total of 226 612 births by 198 590 mothers in 29 maternity units were included.

PRIMARY AND SECONDARY OUTCOME MEASURES: We estimated (1) OR of elective and emergency CS adjusted for several risk factors, for example, body mass index, parity, age and size of maternity unit and (2) risk-adjusted proportions of elective and emergency CS to evaluate between-hospital variation.

RESULTS: The CS proportion was stable at 20%-21%, but showed wide variation between units, even in adjusted models. Large units performed significantly more elective CSs than smaller units, and the risk of emergency CS was significantly reduced compared with smaller units. Many of the included risk factors were found to influence the risk of CS. The most important risk factors were breech presentation and previous CS. Four units performed more CSs and one unit fewer CSs than expected.

CONCLUSION: The main risk factors for elective CS were breech presentation and previous CS; for emergency CS they were breech presentation and cephalopelvic disproportion. The proportions of CS were stable during the study period. We found variation in risk-adjusted CS between hospitals in Denmark. Although exhaustive models were applied, the results indicated the presence of systematic variation between hospital units, which was unexpected in a small, well-regulated country such as Denmark.

OriginalsprogEngelsk
Artikelnummere019120
TidsskriftBMJ Open
Vol/bind8
Udgave nummer2
Antal sider9
ISSN2044-6055
DOI
StatusUdgivet - 1. feb. 2018

Fingeraftryk

Denmark
Cohort Studies
Emergencies
Hospital Units
Cephalopelvic Disproportion
Parity
Registries
Hospital Emergency Service
Body Mass Index
Outcome Assessment (Health Care)

Citer dette

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abstract = "OBJECTIVES: The aim of this study was to estimate the effects of risk factors on elective and emergency caesarean section (CS) and to estimate the between-hospital variation of risk-adjusted CS proportions.DESIGN: Historical registry-based cohort study.SETTINGS AND PARTICIPANTS: The study was based on all singleton deliveries in hospital units in Denmark from January 2009 to December 2012. A total of 226 612 births by 198 590 mothers in 29 maternity units were included.PRIMARY AND SECONDARY OUTCOME MEASURES: We estimated (1) OR of elective and emergency CS adjusted for several risk factors, for example, body mass index, parity, age and size of maternity unit and (2) risk-adjusted proportions of elective and emergency CS to evaluate between-hospital variation.RESULTS: The CS proportion was stable at 20{\%}-21{\%}, but showed wide variation between units, even in adjusted models. Large units performed significantly more elective CSs than smaller units, and the risk of emergency CS was significantly reduced compared with smaller units. Many of the included risk factors were found to influence the risk of CS. The most important risk factors were breech presentation and previous CS. Four units performed more CSs and one unit fewer CSs than expected.CONCLUSION: The main risk factors for elective CS were breech presentation and previous CS; for emergency CS they were breech presentation and cephalopelvic disproportion. The proportions of CS were stable during the study period. We found variation in risk-adjusted CS between hospitals in Denmark. Although exhaustive models were applied, the results indicated the presence of systematic variation between hospital units, which was unexpected in a small, well-regulated country such as Denmark.",
keywords = "epidemiology, obstetrics, quality in health care",
author = "Sonja Wehberg and Rikke Guldberg and Gradel, {Kim Oren} and Kesmodel, {Ulrik Schi{\o}ler} and Lis Munk and Andersson, {Charlotte Brix} and J{\o}lving, {Line Riis} and Jan Nielsen and N{\o}rg{\aa}rd, {Bente Mertz}",
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Risk factors and between-hospital variation of caesarean section in Denmark : a cohort study. / Wehberg, Sonja; Guldberg, Rikke; Gradel, Kim Oren; Kesmodel, Ulrik Schiøler; Munk, Lis; Andersson, Charlotte Brix; Jølving, Line Riis; Nielsen, Jan; Nørgård, Bente Mertz.

I: BMJ Open, Bind 8, Nr. 2, e019120, 01.02.2018.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Risk factors and between-hospital variation of caesarean section in Denmark

T2 - a cohort study

AU - Wehberg, Sonja

AU - Guldberg, Rikke

AU - Gradel, Kim Oren

AU - Kesmodel, Ulrik Schiøler

AU - Munk, Lis

AU - Andersson, Charlotte Brix

AU - Jølving, Line Riis

AU - Nielsen, Jan

AU - Nørgård, Bente Mertz

N1 - © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

PY - 2018/2/1

Y1 - 2018/2/1

N2 - OBJECTIVES: The aim of this study was to estimate the effects of risk factors on elective and emergency caesarean section (CS) and to estimate the between-hospital variation of risk-adjusted CS proportions.DESIGN: Historical registry-based cohort study.SETTINGS AND PARTICIPANTS: The study was based on all singleton deliveries in hospital units in Denmark from January 2009 to December 2012. A total of 226 612 births by 198 590 mothers in 29 maternity units were included.PRIMARY AND SECONDARY OUTCOME MEASURES: We estimated (1) OR of elective and emergency CS adjusted for several risk factors, for example, body mass index, parity, age and size of maternity unit and (2) risk-adjusted proportions of elective and emergency CS to evaluate between-hospital variation.RESULTS: The CS proportion was stable at 20%-21%, but showed wide variation between units, even in adjusted models. Large units performed significantly more elective CSs than smaller units, and the risk of emergency CS was significantly reduced compared with smaller units. Many of the included risk factors were found to influence the risk of CS. The most important risk factors were breech presentation and previous CS. Four units performed more CSs and one unit fewer CSs than expected.CONCLUSION: The main risk factors for elective CS were breech presentation and previous CS; for emergency CS they were breech presentation and cephalopelvic disproportion. The proportions of CS were stable during the study period. We found variation in risk-adjusted CS between hospitals in Denmark. Although exhaustive models were applied, the results indicated the presence of systematic variation between hospital units, which was unexpected in a small, well-regulated country such as Denmark.

AB - OBJECTIVES: The aim of this study was to estimate the effects of risk factors on elective and emergency caesarean section (CS) and to estimate the between-hospital variation of risk-adjusted CS proportions.DESIGN: Historical registry-based cohort study.SETTINGS AND PARTICIPANTS: The study was based on all singleton deliveries in hospital units in Denmark from January 2009 to December 2012. A total of 226 612 births by 198 590 mothers in 29 maternity units were included.PRIMARY AND SECONDARY OUTCOME MEASURES: We estimated (1) OR of elective and emergency CS adjusted for several risk factors, for example, body mass index, parity, age and size of maternity unit and (2) risk-adjusted proportions of elective and emergency CS to evaluate between-hospital variation.RESULTS: The CS proportion was stable at 20%-21%, but showed wide variation between units, even in adjusted models. Large units performed significantly more elective CSs than smaller units, and the risk of emergency CS was significantly reduced compared with smaller units. Many of the included risk factors were found to influence the risk of CS. The most important risk factors were breech presentation and previous CS. Four units performed more CSs and one unit fewer CSs than expected.CONCLUSION: The main risk factors for elective CS were breech presentation and previous CS; for emergency CS they were breech presentation and cephalopelvic disproportion. The proportions of CS were stable during the study period. We found variation in risk-adjusted CS between hospitals in Denmark. Although exhaustive models were applied, the results indicated the presence of systematic variation between hospital units, which was unexpected in a small, well-regulated country such as Denmark.

KW - epidemiology

KW - obstetrics

KW - quality in health care

U2 - 10.1136/bmjopen-2017-019120

DO - 10.1136/bmjopen-2017-019120

M3 - Journal article

C2 - 29440158

VL - 8

JO - B M J Open

JF - B M J Open

SN - 2044-6055

IS - 2

M1 - e019120

ER -