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Comparative Study
. 2011;6(11):e28060.
doi: 10.1371/journal.pone.0028060. Epub 2011 Nov 23.

Risk adjustment for inter-hospital comparison of caesarean delivery rates in low-risk deliveries

Elisa Stivanello  1 , Paola Rucci, Elisa Carretta, Giulia Pieri, Chiara Seghieri, Sabina Nuti, Eugene Declercq, Martina Taglioni, Maria Pia Fantini
Affiliations
Comparative Study

Risk adjustment for inter-hospital comparison of caesarean delivery rates in low-risk deliveries

Elisa Stivanello et al. PLoS One. 2011.

Abstract

Background: Caesarean 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.

Methods: Hospital 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.

Results: Adjusted 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.

Conclusion: Risk 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.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Funnel plot showing the relationship between the number of deliveries and NTCS CD rates in the hospitals of Tuscany.
Dashed lines indicate the 95% and 99.8% CI for the CD rates.
See this image and copyright information in PMC

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