Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Massachusetts General Hospital, Boston, Massachusetts.
J Surg Res. 2020 Jan;245:288-294. doi: 10.1016/j.jss.2019.07.027. Epub 2019 Aug 14.
Although guidelines for clinical indications of cesarean sections (CS) exist, nonclinical factors may affect CS practices. We hypothesize that CS rates vary by day of the week.
An analysis of the Office of Statewide Health Planning and Development database for California from 2006 to 2010 was performed. All patients admitted to a teaching or nonteaching hospital for attempted vaginal delivery were included. Patients who died within 24 h of admission were excluded. Weekend days were defined as Saturday and Sunday, and weekdays were defined as Monday to Friday. The primary outcome was CS versus vaginal delivery. Multivariable analysis was performed, adjusting for patient demographics, clinical factors, and system variables.
A total of 1,855,675 women were included. The overall CS rate was 9.02%. On unadjusted analysis, CS rates were significantly lower on weekends versus weekdays (6.65% versus 9.58%, P < 0.001). On adjusted analysis, women were 27% less likely to have a CS on weekends than on weekdays (odds ratio [OR] 0.73, 95% confidence interval [CI] 0.71-0.75, P < 0.001). In addition, Hispanic ethnicity and delivery in teaching hospitals were associated with a decreased likelihood of CS (OR 0.91, 95% CI 0.86-0.96, P = 0.01; OR 0.80, 95% CI 0.69-0.93, P < 0.001, respectively).
CS rates are significantly decreased on weekends relative to weekdays, even when controlling for patient, hospital, and system factors.
尽管存在剖宫产临床指征指南，但非临床因素可能会影响剖宫产的实施。我们假设剖宫产率因星期几而异。
对加利福尼亚州 2006 年至 2010 年的州卫生规划和发展办公室数据库进行了分析。所有因阴道分娩而入院的教学或非教学医院的患者均包括在内。入院 24 小时内死亡的患者被排除在外。周末指星期六和星期天，工作日指星期一至星期五。主要结局是剖宫产与阴道分娩。进行了多变量分析，调整了患者人口统计学，临床因素和系统变量。
共有 1,855,675 名女性被纳入研究。总体剖宫产率为 9.02%。在未调整的分析中，周末的剖宫产率明显低于工作日（6.65%比 9.58%，P<0.001）。在调整分析中，周末行剖宫产的可能性比工作日低 27%（优势比[OR]0.73，95%置信区间[CI]0.71-0.75，P<0.001）。此外，西班牙裔和在教学医院分娩与剖宫产可能性降低相关（OR 0.91，95%CI 0.86-0.96，P=0.01；OR 0.80，95%CI 0.69-0.93，P<0.001）。
即使控制了患者、医院和系统因素，周末的剖宫产率仍明显低于工作日。
