Variation in the rates of operative delivery in the United States

Steven L. Clark, Michael A. Belfort, Gary D.V. Hankins, Janet A. Meyers, Frank M. Houser

Research output: Contribution to journalArticle

93 Scopus citations

Abstract

Objectives: This study was undertaken to examine the national and regional rates of operative delivery among almost one quarter million births in a single year in the nation's largest healthcare delivery system, using variation as an arbiter of the quality of decision making. Study Design: We compared the variation in rates of primary cesarean and operative vaginal delivery in facilities of the Hospital Corporation of America during the year 2004. Results: In 124 facilities representing almost 220,000 births during a 1-year period, the primary cesarean and operative vaginal delivery rates were 19% ± 5% (range 9-37) and 7% ± 4% (range 1-23). Within individual geographic regions, we consistently found variations of 200-300% in rates of primary cesarean delivery and variations approximating an order of magnitude for operative vaginal delivery. Conclusion: Within broad upper and lower limits, rates of operative delivery in the United States are highly variable and suggest a pattern of almost random decision making. This reflects a lack of sufficient reliable, outcomes-based data to guide clinical decision making.

Original languageEnglish (US)
Pages (from-to)526.e1-526.e5
JournalAmerican journal of obstetrics and gynecology
Volume196
Issue number6
DOIs
StatePublished - Jun 2007

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Keywords

  • cesarean delivery
  • operative vaginal delivery
  • quality of care

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Clark, S. L., Belfort, M. A., Hankins, G. D. V., Meyers, J. A., & Houser, F. M. (2007). Variation in the rates of operative delivery in the United States. American journal of obstetrics and gynecology, 196(6), 526.e1-526.e5. https://doi.org/10.1016/j.ajog.2007.01.024