Abstract
Objective
To determine the influence of delivery hospital on the rate of vaginal birth after cesarean (VBAC).
Study design
This retrospective cohort study used claims data from Blue Cross and Blue Shield of Michigan. Women with a prior cesarean and a singleton livebirth between 2012 and 2016 were included. We calculated the hospital-specific risk-standardized VBAC rates and median odds ratio as a measure of variation.
Result
Hospital-level adjusted rates varied nearly tenfold (3.7%–35.5%). Compared to the lowest volume hospitals (1st quartile), the likelihood of VBAC increased for those in the 2nd (adjusted OR 2.75 [95% CI 1.23–6.17]), 3rd (adjusted OR 3.73 [95% CI 1.59–8.75]), and 4th quartiles (adjusted OR 2.9 [95% CI 1.11–7.72]). The median OR suggested significant variation by hospital after adjustment.
Conclusion
The delivery hospital itself explains a large amount of the variation in rates of VBAC after adjustment for patient and hospital characteristics.
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Code availability
Risk and reliability-adjustment, median OR, and 80% interval OR available by request to corresponding author.
References
Martin JA, Hamilton BE, Osterman MJK, Driscoll AK, Mathews TJ. Births: Final data for 2015. Natl Vital Stat Rep. 2017;66:1.
American College of Obstetricians and Gynecologists. Practice Bulletin No. 184. Vaginal birth after cesarean delivery. Obstet Gynecol. 2017;130:e217–33.
Martin JA, Hamilton BE, Osterman MJK, Driscoll AK, Drake P. Births: Final data for 2016. Natl Vital Stat Rep. 2018;67:1–54.
Grobman WA, Lai Y, Landon MB, Spong CY, Leveno KJ, Rouse DJ, et al. Development of a nomogram for prediction of vaginal birth after cesarean delivery. Obstet Gynecol. 2007;109:806–12.
Grobman WA, Lai Y, Landon MB, Spong CY, Rouse DJ, Varner MW, et al. The change in the rate of vaginal birth after caesarean section. Paediatr Perinat Epidemiol. 2011;25:37–43.
Bernstein SN, Matalon-Grazi S, Rosenn BM. Trial of labor versus repeat cesarean: are patients making an informed decision? Am J Obstet Gynecol. 2012;207:204.e1–6.
Yee LM, Liu LY, Grobman WA. Relationship between obstetricians’ cognitive and affective traits and delivery outcomes among women with a prior cesarean. Am J Obstet Gynecol. 2015;213:413.e1–7.
Yee LM, Liu LY, Grobman WA. Obstetrician call schedule and obstetric outcomes among women eligible for a trial of labor after cesarean. Am J Obstet Gynecol. 2017;216:75e1–6.
Metz TD, Stoddard GJ, Henry E, Jackson M, Holmgren C, Esplin S. How do good candidates for trial of labor after cesarean (TOLAC) who undergo elective repeat cesarean differ from those who choose TOLAC? Am J Obstet Gynecol. 2013;208:458.e1–6.
Office of Disease Prevention and Health Promotion, Healthy People 2020. Maternal, Infant, and Child Health. Available from: https://www.healthypeople.gov/2020/topics-objectives/topic/maternal-infant-and-child-health/objectives. Accessed 8 Feb, 2018.
Guise JM, Eden K, Emeis C, Denman MA, Marshall N, Fu R, et al. Vaginal birth after cesarean: new insights. Evidence Report/Technology Assessment No. 191. Prepared by the Oregon Health & Science University Evidence-based Practice Center under Contract No. 290-2007-10057-I. AHRQ Publication No. 2010;10–E003. Rockville, MD: Agency for Healthcare Research and Quality. March 2010.
Rosenstein MG, Kuppermann M, Gregorich SE, Cottrell EK, Caughey AB, Cheng YW. Association between vaginal birth after cesarean delivery and primary cesarean delivery rates. Obstet Gynecol. 2013;122:1010–7.
Kozhimannil KB, Law MR, Virnig BA. Cesarean delivery rates vary tenfold among US hospitals; reducing variation may address quality and cost issues. Health Aff (Millwood). 2013;32:527–35.
Friedman AM, Ananth CV, Prendergast E, D’Alton ME, Wright JD. Variation in and factors associated with use of episiotomy. JAMA. 2015;313:197–9.
DeFranco EA, Rampersad R, Atkins KL, Odibo AO, Stevens EJ, Peipert JF, et al. Do vaginal birth after cesarean outcomes differ based on hospital setting? Am J Obstet Gynecol. 2007;197:440.e1–6.
Ellimoottil C, Syrjamaki JD, Voit B, Guduquntla V, Miller DC, Dupree JM. Validation of a claims-based algorithm to characterize episodes of care. Am J Manag Care. 2017;23:e382–6.
Landon MB, Leindecker S, Spong CY, Hauth JC, Bloom S, Varner MW, et al. The MFMU Cesarean Registry: factors affecting the success of trial of labor after previous cesarean delivery. Am J Obstet Gynecol. 2005;193:1016–23.
Agency for Healthcare Research and Quality. Re-Engineered Discharge (RED) Toolkit: How CMS Measures the “30-Day All Cause Rehospitalization Rate” on the Hospital Compare Web Site. Available from: https://www.ahrq.gov/professionals/systems/hospital/red/toolkit/redtool-30day.html. Accessed 8 Feb, 2018.
Larsen K, Petersen JH, Budtz-Jørgensen E, Endahl L. Interpreting parameters in the logistic regression model with random effects. Biometrics. 2000;56:909–14.
Merlo J, Chaix B, Ohlsson H, Beckman A, Johnell K, Hjerpe P, et al. A brief conceptual tutorial of multilevel analysis in social epidemiology: using measures of clustering in multilevel logistic regression to investigate contextual phenomena. J Epidemiol Community Health. 2006;60:290–7.
Girotra S, van Diepen S, Nallamothu BK, Carrel M, Vellano K, Anderson ML, et al. Regional variation in out-of-hospital cardiac arrest survival in the United States. Circulation. 2016;133:2159–68.
Prescott HC, Kepreos KM, Wiitala WL, Iwashyna TJ. Temporal changes in the influence of hospitals and regional healthcare networks on severe sepsis mortality. Crit Care Med. 2015;43:1368–74.
American College of Obstetricians and Gynecologists. Obstetric care consensus No. 2. Levels of maternal care. Obstet Gynecol. 2015;125:502–15.
Acknowledgements
Ms. Sarah Block assisted in preparation of this manuscript. Mr. Ryan Jakubowski assisted with graphic design for the figures.
Funding
Dr. Moniz receives support from the Agency for Healthcare Research and Quality (AHRQ) under award number K08 HS025465.
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Dr. Langen, Dr. Moniz, Dr. Morgan, Mr. Kamdar, and Mr. Syrjamaki receive salary support from Blue Cross Blue Shield of Michigan (BCBSM). Mr. Kamdar is a consultant for Lucent Surgical. The other authors declare that they have no conflict of interest.
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Triebwasser, J.E., Kamdar, N.S., Langen, E.S. et al. Hospital contribution to variation in rates of vaginal birth after cesarean. J Perinatol 39, 904–910 (2019). https://doi.org/10.1038/s41372-019-0373-2
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DOI: https://doi.org/10.1038/s41372-019-0373-2
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