Cesarean sections are an important delivery option for mothers experiencing complicated births and have been growing more common over the past few decades. Because they are associated with greater costs and risks of complications for both mothers and newborns, analysts have tried to determine what is driving higher rates of C-sections. Some have found that the rate varies substantially from hospital to hospital, regardless of patient health or risk factors. The following list identifies the top 20 hospitals by C-section rate and overall volume using ICD9 codes and estimated births, based on Definitive Healthcare data.
The estimated rate of C-sections was determined by comparing claims volume for ICD9 codes 740, 741, 742, 744, and 7499 for 2015, the latest year available, and estimated births for 2016. Despite the year difference, the birth volume for most hospitals with established maternity programs does not vary significantly from year to year. Only hospitals with over 100 estimated C-sections were included. Of the 20 top hospitals by rate, nearly three quarters had higher case mixes than the median (1.47) of other hospitals that had births in 2016. Previous research has found a correlation between case mix severity and C-section rate, as patients with complicating conditions may not be best suited for natural delivery, such as those who are significantly overweight or have diabetes. However, most studies have found other factors play a role as well, such as fear of medical liability from natural delivery complications, physician attitudes towards surgery, and care delivery models. In addition, women whose first child was born through a C-section tend to undergo C-sections for all following children, which can inflate the procedure volume for certain populations.
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