Trend in primary caesarean delivery: a five-year experience in ABRUZZO, ITALY
Abstract Background Primary caesarean section (PCS) rate is one of the main indicators of quality of care suggested by the Italian Government. Hospital rankings are usually based on it, therefore lower rates reflect more appropriate clinical practice. The aim of this study is to describe a five-year...
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| Format: | Article |
| Language: | English |
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BMC
2018-07-01
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| Series: | BMC Health Services Research |
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| Online Access: | http://link.springer.com/article/10.1186/s12913-018-3332-2 |
| _version_ | 1818060155606007808 |
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| author | Pamela Di Giovanni Tonia Garzarella Giuseppe Di Martino Francesco Saverio Schioppa Ferdinando Romano Tommaso Staniscia |
| author_facet | Pamela Di Giovanni Tonia Garzarella Giuseppe Di Martino Francesco Saverio Schioppa Ferdinando Romano Tommaso Staniscia |
| author_sort | Pamela Di Giovanni |
| collection | DOAJ |
| description | Abstract Background Primary caesarean section (PCS) rate is one of the main indicators of quality of care suggested by the Italian Government. Hospital rankings are usually based on it, therefore lower rates reflect more appropriate clinical practice. The aim of this study is to describe a five-year trend of PCS rate in Abruzzo region from 2009 to 2013 and to examine the medical indications for this mode of delivery. Methods Forty-five thousand one hundred forty-nine deliveries occurring from 2009 to 2013 were collected from all hospital discharge records (HDR) and analyzed. Among them we found 12,542 PCS. Odds ratios (ORs) with 95% confidence interval (95% CI) were estimated using logistic regression methods to evaluate the relationship between maternal risk factors and PCS in hospital over 1000 delivery/yrs. Results The five-year PCS rate was 28.9%, with a decreasing trend from 31.4% in 2009 to 26.1% in 2013. Vasto Civil Hospital shows the lowest PCS rate (17.9% in 2013) among hospitals with a maximum of 1000 deliveries per year, while Pescara Civil Hospital shows the lowest PCS rate (25.4% in 2013) among hospitals with over 1000 deliveries per year. Women with major risk factors for cesarean section delivered more frequently in maternity units over 1000 delivery/yrs. Logistic regression analyses showed as diabetes, hypertension, twin pregnancy, fetal distress and preterm delivery were significant risk factors to deliver in unit over 1000 delivery/yrs. The most frequent (overall 66.6%) discharge diagnosis recorded in Hospital discharge records (HDR) is “Caesarean Delivery Without Indication”. 7.3% of PCS made in Abruzzo concerns women living in other Italian regions. 11.4% of PCS contains one of the indications to caesarean section (CS) that the Italian Guidelines consider appropriate. Conclusions During the analyzed period, Abruzzo showed a decreasing, but still too high, PCS rate, compared to the limits fixed by the Italian Ministry of Health. Considering the limitation of this study, based on administrative data that are poor in clinical information, it is not possible to define the appropriateness of all caesarean sections. |
| first_indexed | 2024-12-10T13:27:56Z |
| format | Article |
| id | doaj.art-afff3feb90934aec9985bc5d8c2f8919 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-12-10T13:27:56Z |
| publishDate | 2018-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-afff3feb90934aec9985bc5d8c2f89192022-12-22T01:47:06ZengBMCBMC Health Services Research1472-69632018-07-011811610.1186/s12913-018-3332-2Trend in primary caesarean delivery: a five-year experience in ABRUZZO, ITALYPamela Di Giovanni0Tonia Garzarella1Giuseppe Di Martino2Francesco Saverio Schioppa3Ferdinando Romano4Tommaso Staniscia5Department of Pharmacy, “G. d’Annunzio” University of Chieti-PescaraPostgraduate School of Public Health and Preventive Medicine, “G. d’Annunzio” University of Chieti-PescaraPostgraduate School of Public Health and Preventive Medicine, “G. d’Annunzio” University of Chieti-PescaraPostgraduate School of Public Health and Preventive Medicine, “G. d’Annunzio” University of Chieti-PescaraDepartment of Public Health and Infectious Diseases, “La Sapienza” University of RomePostgraduate School of Public Health and Preventive Medicine, “G. d’Annunzio” University of Chieti-PescaraAbstract Background Primary caesarean section (PCS) rate is one of the main indicators of quality of care suggested by the Italian Government. Hospital rankings are usually based on it, therefore lower rates reflect more appropriate clinical practice. The aim of this study is to describe a five-year trend of PCS rate in Abruzzo region from 2009 to 2013 and to examine the medical indications for this mode of delivery. Methods Forty-five thousand one hundred forty-nine deliveries occurring from 2009 to 2013 were collected from all hospital discharge records (HDR) and analyzed. Among them we found 12,542 PCS. Odds ratios (ORs) with 95% confidence interval (95% CI) were estimated using logistic regression methods to evaluate the relationship between maternal risk factors and PCS in hospital over 1000 delivery/yrs. Results The five-year PCS rate was 28.9%, with a decreasing trend from 31.4% in 2009 to 26.1% in 2013. Vasto Civil Hospital shows the lowest PCS rate (17.9% in 2013) among hospitals with a maximum of 1000 deliveries per year, while Pescara Civil Hospital shows the lowest PCS rate (25.4% in 2013) among hospitals with over 1000 deliveries per year. Women with major risk factors for cesarean section delivered more frequently in maternity units over 1000 delivery/yrs. Logistic regression analyses showed as diabetes, hypertension, twin pregnancy, fetal distress and preterm delivery were significant risk factors to deliver in unit over 1000 delivery/yrs. The most frequent (overall 66.6%) discharge diagnosis recorded in Hospital discharge records (HDR) is “Caesarean Delivery Without Indication”. 7.3% of PCS made in Abruzzo concerns women living in other Italian regions. 11.4% of PCS contains one of the indications to caesarean section (CS) that the Italian Guidelines consider appropriate. Conclusions During the analyzed period, Abruzzo showed a decreasing, but still too high, PCS rate, compared to the limits fixed by the Italian Ministry of Health. Considering the limitation of this study, based on administrative data that are poor in clinical information, it is not possible to define the appropriateness of all caesarean sections.http://link.springer.com/article/10.1186/s12913-018-3332-2Primary caesarean sectionTrendQuality of careDischarge diagnosisAppropriatenessRobson classification |
| spellingShingle | Pamela Di Giovanni Tonia Garzarella Giuseppe Di Martino Francesco Saverio Schioppa Ferdinando Romano Tommaso Staniscia Trend in primary caesarean delivery: a five-year experience in ABRUZZO, ITALY BMC Health Services Research Primary caesarean section Trend Quality of care Discharge diagnosis Appropriateness Robson classification |
| title | Trend in primary caesarean delivery: a five-year experience in ABRUZZO, ITALY |
| title_full | Trend in primary caesarean delivery: a five-year experience in ABRUZZO, ITALY |
| title_fullStr | Trend in primary caesarean delivery: a five-year experience in ABRUZZO, ITALY |
| title_full_unstemmed | Trend in primary caesarean delivery: a five-year experience in ABRUZZO, ITALY |
| title_short | Trend in primary caesarean delivery: a five-year experience in ABRUZZO, ITALY |
| title_sort | trend in primary caesarean delivery a five year experience in abruzzo italy |
| topic | Primary caesarean section Trend Quality of care Discharge diagnosis Appropriateness Robson classification |
| url | http://link.springer.com/article/10.1186/s12913-018-3332-2 |
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