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Hospital volume and cesarean delivery among low-risk women in a nationwide sample



We sought to determine if hospital delivery volume was associated with a patient’s risk for cesarean delivery in low-risk women.

Study Design:

This study retrospectively examines a cohort of 1 657 495 deliveries identified in the 2013 Nationwide Readmissions Database. Hospitals were stratified by delivery volume quartiles. Low-risk patients were identified using the Society for Maternal–Fetal Medicine definition (n=845 056). A multivariable logistic regression accounting for hospital-level clustering was constructed to assess the factors affecting a patient’s odds for cesarean delivery.


The range of cesarean delivery rates was 2.4–51.2% among low-risk patients, and the median was 16.5% (IQR 12.8–20.5%). The cesarean delivery rate was higher in the top two-volume-quartile hospitals (17.4 and 18.2%) compared to the bottom quartiles (16.4 and 16.3%) (P<0.001). Hospital volume was not associated with a patient’s odds for cesarean delivery after adjusting for patient and other hospital characteristics (P=0.188).


Hospital delivery volume is not an independent predictor of cesarean delivery in this population.

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We acknowledge the AHRQ’s HCUP Data Partners that contributed data to the Nationwide Readmissions Database: Alaska, Arizona, Arkansas, California, Colorado, Connecticut, District of Columbia, Florida, Georgia, Hawaii, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin and Wyoming.

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Correspondence to M A Clapp.

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Clapp, M., James, K., Melamed, A. et al. Hospital volume and cesarean delivery among low-risk women in a nationwide sample. J Perinatol 38, 127–131 (2018).

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