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

Objective: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.results: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).conclusion:hospital delivery volume is not an independent predictor of cesarean delivery in this population.