Cesarean delivery is the most common inpatient surgery in the United States, where 1.3 million cesarean sections occur annually, and rates vary widely by hospital. Identifying sources of variation in cesarean use is crucial to improving the consistency and quality of obstetric care. The authors in this study used hospital discharge records to examine the extent to which variability in the likelihood of cesarean section across US hospitals was attributable to individual women's clinical diagnoses. Findings suggest that variability across hospitals in the individual risk of cesarean section is not decreased by accounting for differences in maternal diagnoses. These findings highlight the need for more comprehensive or linked data including parity and gestational age as well as examination of other factors—such as hospital policies, practices, and culture—in determining cesarean section use.



  1. US Centers for Disease Control and Prevention (2014) FastStats: inpatient surgery. Available: http://www.cdc.gov/nchs/fastats/inpatien​t-surgery.htm.

  2. Menacker F, Hamilton BE (2010) Recent trends in cesarean delivery in the United States. NCHS Data Brief 35: 1–8. doi: 10.1037/e665412010-001.

  3. Osterman MJK, Martin JA (2013) Changes in cesarean delivery rates by gestational age: United States, 1996–2011. NCHS Data Brief 124: 1–8.


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