Cesarean Delivery Rates Vary Tenfold Among US Hospitals; Reducing Variation May Address Quality And Cost Issues

TLDR

Cesarean delivery is the most common surgical procedure in the U.S., with rates rising and varying widely across hospitals. The study aims to reduce cesarean variation by focusing on four promising directions: better coordinating maternity care, collecting and measuring more data, tying Medicaid payment to quality improvement, and enhancing patient‑centered decision making through public reporting. The authors propose these four strategies as mechanisms to achieve reduced variation. Analysis of 2009 data from 593 hospitals revealed cesarean rates varied tenfold overall (7.1–69.9%) and fifteenfold among low‑risk pregnancies (2.4–36.5%), indicating costly overuse driven by practice variation.

Abstract

Cesarean delivery is the most commonly performed surgical procedure in the United States, and cesarean rates are increasing. Working with 2009 data from 593 US hospitals nationwide, we found that cesarean rates varied tenfold across hospitals, from 7.1 percent to 69.9 percent. Even for women with lower-risk pregnancies, in which more limited variation might be expected, cesarean rates varied fifteenfold, from 2.4 percent to 36.5 percent. Thus, vast differences in practice patterns are likely to be driving the costly overuse of cesarean delivery in many US hospitals. Because Medicaid pays for nearly half of US births, government efforts to decrease variation are warranted. We focus on four promising directions for reducing these variations, including better coordinating maternity care, collecting and measuring more data, tying Medicaid payment to quality improvement, and enhancing patient-centered decision making through public reporting.