Sinnott Sarah-Jo, Brick Aoife, Layte Richard, Cunningham Nathan, Turner Michael J
Economic and Social Research Institute, Whitaker Square, Dublin 2, Ireland.
Trinity College, Dublin, Ireland.
PLoS One. 2016 Jun 9;11(6):e0156172. doi: 10.1371/journal.pone.0156172. eCollection 2016.
Internationally, caesarean section (CS) rates are rising. However, mean rates of CS across providers obscure extremes of CS provision. We aimed to quantify variation between all maternity units in Ireland.
Two national databases, the National Perinatal Reporting System and the Hospital Inpatient Enquiry Scheme, were used to analyse data for all women delivering singleton births weighing ≥500g. We used multilevel models to examine variation between hospitals in Ireland for elective and emergency CS, adjusted for individual level sociodemographic, clinical and organisational variables. Analyses were subsequently stratified for nullipara and multipara with and without prior CS.
The national CS rate was 25.6% (range 18.2% ─ 35.1%). This was highest in multipara with prior CS at 86.1% (range 6.9% ─ 100%). The proportion of variation in CS that was attributable to the hospital of birth was 11.1% (95% CI, 6.0 ─ 19.4) for elective CS and 2.9% (95% CI, 1.4 ─ 5.6) for emergency CS, after adjustment. Stratifying across parity group, variation between hospitals was greatest for multipara with prior CS. Both types of CS were predicted by increasing age, prior history of miscarriage or stillbirth, prior CS, antenatal complications and private model of care.
The proportion of variation attributable to the hospital was higher for elective CS than emergency CS suggesting that variation is more likely influenced by antenatal decision making than intrapartum decision making. Multipara with prior CS were particularly subject to variability, highlighting a need for consensus on appropriate care in this group.
在国际上，剖宫产（CS）率正在上升。然而，各医疗服务提供者的平均剖宫产率掩盖了剖宫产率的极端情况。我们旨在量化爱尔兰所有产科单位之间的差异。
使用两个国家数据库，即国家围产期报告系统和医院住院患者查询计划，分析所有分娩体重≥500g单胎婴儿的妇女的数据。我们使用多层次模型来研究爱尔兰各医院在择期和急诊剖宫产方面的差异，并对个体层面的社会人口统计学、临床和组织变量进行了调整。随后，对初产妇和经产妇进行分层分析，包括有或无既往剖宫产史的情况。
全国剖宫产率为25.6%（范围为18.2% - 35.1%）。既往有剖宫产史的经产妇中这一比例最高，为86.1%（范围为6.9% -
100%）。调整后，因分娩医院导致的剖宫产差异比例在择期剖宫产中为11.1%（95%置信区间为6.0 - 19.4），在急诊剖宫产中为2.9%（95%置信区间为1.4 - 5.6）。按产次分组进行分层分析，既往有剖宫产史的经产妇中各医院之间差异最大。两种类型的剖宫产都与年龄增加、既往流产或死产史、既往剖宫产史、产前并发症以及私立医疗模式有关。
择期剖宫产中因医院导致的差异比例高于急诊剖宫产，这表明差异更可能受产前决策而非产时决策的影响。既往有剖宫产史的经产妇尤其容易出现差异，这凸显了在这一群体中就适当护理达成共识的必要性。
