Nonclinical parameters affecting primary cesarean rates in the united states

Shoshana Haberman*, Sumit Saraf, Jun Zhang, Helain J. Landy, D. W. Branch, Ronald Burkman, Kimberly D. Gregory, Mildred M. Ramirez, Jennifer L. Bailit, Victor H. Gonzalez-Quintero, Judith U. Hibbard, Matthew K. Hoffman, Michelle Kominiarek, Li Lu, Paul Van Veldhuisen, Vivian Von Gruenigen

*Corresponding author for this work

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Objective Cesarean is the single most common operation in United States and has reached epidemic proportions in recent decades. Our objective was to study the effect of nonclinical parameters on primary cesarean rates in a large contemporary population. Study Design We designed a retrospective multicenter study using data obtained from electronic medical records from 19 U.S. hospitals between 2005 and 2007 (Consortium on Safe Labor Database), which included 145,764 term, singleton, nonanomalous, vertex, live births that included labor. The impact of nonclinical parameters (patient and provider characteristics, time of delivery, institutional policies, and insurance type) was investigated using modified Poisson regression methodology and classification and regression tree analysis. Results There were 125,517 vaginal and 20,247 cesarean deliveries. Using the multivariable model, the nonclinical parameters with statistical significance for primary cesarean were delivery during evening hours, a male provider, public insurance, and nonwhite race (p < 0.001). Conclusions Cesarean rates are associated with several nonclinical factors. Further investigation into these factors might help to develop strategies to reduce their influence and hence the rates of cesarean.

Original languageEnglish (US)
Pages (from-to)213-221
Number of pages9
JournalAmerican Journal of Perinatology
Volume31
Issue number3
DOIs
StatePublished - Mar 1 2014

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Insurance
Organizational Policy
Electronic Health Records
Live Birth
Multicenter Studies
Retrospective Studies
Regression Analysis
Databases
Population

Keywords

  • cesarean section rates
  • nonclinical factors
  • physician factors

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

Cite this

Haberman, S., Saraf, S., Zhang, J., Landy, H. J., Branch, D. W., Burkman, R., ... Von Gruenigen, V. (2014). Nonclinical parameters affecting primary cesarean rates in the united states. American Journal of Perinatology, 31(3), 213-221. https://doi.org/10.1055/s-0033-1345263
Haberman, Shoshana ; Saraf, Sumit ; Zhang, Jun ; Landy, Helain J. ; Branch, D. W. ; Burkman, Ronald ; Gregory, Kimberly D. ; Ramirez, Mildred M. ; Bailit, Jennifer L. ; Gonzalez-Quintero, Victor H. ; Hibbard, Judith U. ; Hoffman, Matthew K. ; Kominiarek, Michelle ; Lu, Li ; Van Veldhuisen, Paul ; Von Gruenigen, Vivian. / Nonclinical parameters affecting primary cesarean rates in the united states. In: American Journal of Perinatology. 2014 ; Vol. 31, No. 3. pp. 213-221.
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author = "Shoshana Haberman and Sumit Saraf and Jun Zhang and Landy, {Helain J.} and Branch, {D. W.} and Ronald Burkman and Gregory, {Kimberly D.} and Ramirez, {Mildred M.} and Bailit, {Jennifer L.} and Gonzalez-Quintero, {Victor H.} and Hibbard, {Judith U.} and Hoffman, {Matthew K.} and Michelle Kominiarek and Li Lu and {Van Veldhuisen}, Paul and {Von Gruenigen}, Vivian",
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Haberman, S, Saraf, S, Zhang, J, Landy, HJ, Branch, DW, Burkman, R, Gregory, KD, Ramirez, MM, Bailit, JL, Gonzalez-Quintero, VH, Hibbard, JU, Hoffman, MK, Kominiarek, M, Lu, L, Van Veldhuisen, P & Von Gruenigen, V 2014, 'Nonclinical parameters affecting primary cesarean rates in the united states', American Journal of Perinatology, vol. 31, no. 3, pp. 213-221. https://doi.org/10.1055/s-0033-1345263

Nonclinical parameters affecting primary cesarean rates in the united states. / Haberman, Shoshana; Saraf, Sumit; Zhang, Jun; Landy, Helain J.; Branch, D. W.; Burkman, Ronald; Gregory, Kimberly D.; Ramirez, Mildred M.; Bailit, Jennifer L.; Gonzalez-Quintero, Victor H.; Hibbard, Judith U.; Hoffman, Matthew K.; Kominiarek, Michelle; Lu, Li; Van Veldhuisen, Paul; Von Gruenigen, Vivian.

In: American Journal of Perinatology, Vol. 31, No. 3, 01.03.2014, p. 213-221.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Nonclinical parameters affecting primary cesarean rates in the united states

AU - Haberman, Shoshana

AU - Saraf, Sumit

AU - Zhang, Jun

AU - Landy, Helain J.

AU - Branch, D. W.

AU - Burkman, Ronald

AU - Gregory, Kimberly D.

AU - Ramirez, Mildred M.

AU - Bailit, Jennifer L.

AU - Gonzalez-Quintero, Victor H.

AU - Hibbard, Judith U.

AU - Hoffman, Matthew K.

AU - Kominiarek, Michelle

AU - Lu, Li

AU - Van Veldhuisen, Paul

AU - Von Gruenigen, Vivian

PY - 2014/3/1

Y1 - 2014/3/1

N2 - Objective Cesarean is the single most common operation in United States and has reached epidemic proportions in recent decades. Our objective was to study the effect of nonclinical parameters on primary cesarean rates in a large contemporary population. Study Design We designed a retrospective multicenter study using data obtained from electronic medical records from 19 U.S. hospitals between 2005 and 2007 (Consortium on Safe Labor Database), which included 145,764 term, singleton, nonanomalous, vertex, live births that included labor. The impact of nonclinical parameters (patient and provider characteristics, time of delivery, institutional policies, and insurance type) was investigated using modified Poisson regression methodology and classification and regression tree analysis. Results There were 125,517 vaginal and 20,247 cesarean deliveries. Using the multivariable model, the nonclinical parameters with statistical significance for primary cesarean were delivery during evening hours, a male provider, public insurance, and nonwhite race (p < 0.001). Conclusions Cesarean rates are associated with several nonclinical factors. Further investigation into these factors might help to develop strategies to reduce their influence and hence the rates of cesarean.

AB - Objective Cesarean is the single most common operation in United States and has reached epidemic proportions in recent decades. Our objective was to study the effect of nonclinical parameters on primary cesarean rates in a large contemporary population. Study Design We designed a retrospective multicenter study using data obtained from electronic medical records from 19 U.S. hospitals between 2005 and 2007 (Consortium on Safe Labor Database), which included 145,764 term, singleton, nonanomalous, vertex, live births that included labor. The impact of nonclinical parameters (patient and provider characteristics, time of delivery, institutional policies, and insurance type) was investigated using modified Poisson regression methodology and classification and regression tree analysis. Results There were 125,517 vaginal and 20,247 cesarean deliveries. Using the multivariable model, the nonclinical parameters with statistical significance for primary cesarean were delivery during evening hours, a male provider, public insurance, and nonwhite race (p < 0.001). Conclusions Cesarean rates are associated with several nonclinical factors. Further investigation into these factors might help to develop strategies to reduce their influence and hence the rates of cesarean.

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KW - nonclinical factors

KW - physician factors

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Haberman S, Saraf S, Zhang J, Landy HJ, Branch DW, Burkman R et al. Nonclinical parameters affecting primary cesarean rates in the united states. American Journal of Perinatology. 2014 Mar 1;31(3):213-221. https://doi.org/10.1055/s-0033-1345263