Department of Community & Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
Research Unit, Heimerer College, Prishtina, Kosovo.
BMJ Open. 2021 Jan 28;11(1):e042076. doi: 10.1136/bmjopen-2020-042076.
The aim of this study is to determine the odds of caesarean section in all births in teaching hospitals as compared with non-teaching hospitals.
Over 3600 teaching and non-teaching hospitals in 22 countries. We searched CINAHL, The Cochrane Library, PubMed, sciELO, Scopus and Web of Science from the beginning of records until May 2020.
Women at birth. Over 18.5 million births.
Caesarean section.
The primary outcome measures are the adjusted OR of caesarean section in a variety of teaching hospital comparisons. The secondary outcome is the crude OR of caesarean section in a variety of teaching hospital comparisons.
In adjusted analyses, we found that university hospitals have lower odds than non-teaching hospitals (OR=0.66, 95% CI 0.56 to 0.78) and other teaching hospitals (OR=0.46, 95% CI 0.24 to 0.89), and no significant difference with unspecified teaching status hospitals (OR=0.92, 95% CI 0.80 to 1.05, τ2=0.009). Other teaching hospitals had higher odds than non-teaching hospitals (OR=1.23, 95% CI 1.12 to 1.35). Comparison between unspecified teaching hospitals and non-teaching hospitals (OR=0.91, 95% CI 0.50 to 1.65, τ2=1.007) and unspecified hospitals (OR=0.95, 95% CI 0.76 to 1.20), τ2<0.001) showed no significant difference. While the main analysis in larger sized groups of analysed studies reveals no effect between hospitals, subgroup analyses show that teaching hospitals carry out fewer caesarean sections in several countries, for several study populations and population characteristics.
With smaller sample of participants and studies, in clearly defined hospitals categories under comparison, we see that university hospitals have lower odds for caesarean. With larger sample size and number of studies, as well as less clearly defined categories of hospitals, we see no significant difference in the likelihood of caesarean sections between teaching and non-teaching hospitals. Nevertheless, even in groups with no significant effect, teaching hospitals have a lower or higher likelihood of caesarean sections in several analysed subgroups. Therefore, we recommend a more precise examination of forces sustaining these trends.
CRD42020158437.
本研究旨在比较教学医院和非教学医院的剖宫产率。
来自 22 个国家的 3600 多家教学医院和非教学医院。我们检索了 CINAHL、The Cochrane Library、PubMed、sciELO、Scopus 和 Web of Science，检索时间从建库开始至 2020 年 5 月。
分娩产妇。超过 1850 万例分娩。
剖宫产术。
主要结局测量指标是各种教学医院比较中剖宫产的调整后比值比（OR）。次要结局是各种教学医院比较中剖宫产的未调整 OR。
在调整分析中，我们发现与非教学医院（OR=0.66，95%CI 0.56 至 0.78）和其他教学医院（OR=0.46，95%CI 0.24 至 0.89）相比，大学医院的剖宫产率较低，与未指定教学地位的医院无显著差异（OR=0.92，95%CI 0.80 至 1.05，τ2=0.009）。其他教学医院的剖宫产率高于非教学医院（OR=1.23，95%CI 1.12 至 1.35）。与非教学医院（OR=0.91，95%CI 0.50 至 1.65，τ2=1.007）和未指定医院（OR=0.95，95%CI 0.76 至 1.20，τ2<0.001）相比，未指定教学医院的剖宫产率无显著差异。尽管在分析中较大样本量的研究中未显示出医院间的效果，但亚组分析表明，在几个国家中，一些研究人群和人群特征的教学医院剖宫产率较低。
在较小的参与者样本和研究中，在比较中明确界定的医院类别中，我们发现大学医院的剖宫产率较低。在更大的样本量和更多的研究以及不太明确界定的医院类别中，我们发现教学医院和非教学医院的剖宫产率没有显著差异。然而，即使在没有显著效果的组中，教学医院在几个分析亚组中也有较低或较高的剖宫产率。因此，我们建议更精确地检查维持这些趋势的力量。
PROSPERO 注册号：CRD42020158437。
