(701) Outcomes of cesarean and vaginal delivery in nulliparous deliveries by hospital cesarean delivery rate

It is unknown how outcomes differ among patients delivering in hospitals with differing rates of cesarean delivery. Therefore, we sought to assess an association between patients delivering at hospitals with different cesarean delivery rates and adverse perinatal outcomes stratified by cesarean or vaginal delivery.  

 

Study Design:

This was a retrospective cohort study of singleton, non-anomalous, term deliveries with vertex presentation in nulliparous individuals of California (2016-2020). Using the cesarean delivery rate in each hospital, we categorized hospitals into low (< 22%), medium (22.1-26.3%) and high (≥26.3%) cesarean rate hospitals. Multivariable Poisson regression models were used to examine the association of low and medium cesarean rate hospitals with adverse outcomes, using high cesarean rate hospitals as reference. These association were examined separately among patients delivering via cesarean or vaginally. Adjusted risk ratios (aRR) with 95% CI were estimated. 

Results:

In this study, we included 507,455 deliveries, of which 102,486 (20.2%) were cesarean and 404,968 (79.8%) were vaginal. As compared to high CD rate hospitals, individuals with cesareans in low CD rate hospitals had higher risk of SMM (3.31% vs 1.67%; aRR=2.07 (1.57-2.73)), wound infection (0.50% vs 0.32%; aRR=1.67 (1.11-2.51)), NICU admissions (7.94% vs. 6.01%; aRR=1.42 (1.11-1.81)), and lower Apgar scores (3.16% vs. 1.63%; aRR=1.79 (1.45-2.20)). Results were similar in individuals with vaginal deliveries, such as low CD rate hospitals had higher risk of SMM (1.93% vs 0.84%; aRR=1.92 (1.44-2.58)), wound infection (0.13% vs 0.08%; aRR=1.59 (1.09-2.32)) and lower Apgar scores (1.44% vs 0.93%; aRR=1.43 (1.17-1.74)).

Conclusion:

We found that patients delivering at hospitals with a low cesarean delivery rate had higher rates of several adverse outcomes in both cesarean and vaginal deliveries.  Further investigation should be conducted to further evaluate this relationship.