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Hoxha I, Zhubi E, Grezda K, et al. Caesarean sections in teaching hospitals: systematic review and meta-analysis of hospitals in 22 countries. BMJ Open. 2021;11(1):e042076doi: 10.1136/bmjopen-2020-042076.
Hoxha, I., Zhubi, E., Grezda, K., Kryeziu, B., Bunjaku, J., Sadiku, F., Agahi, R., Lungu, D. A., Bonciani, M., & Little, G. (2021). Caesarean sections in teaching hospitals: systematic review and meta-analysis of hospitals in 22 countries. BMJ open, 11(1), e042076. https://doi.org/10.1136/bmjopen-2020-042076
Hoxha, Ilir, et al. "Caesarean sections in teaching hospitals: systematic review and meta-analysis of hospitals in 22 countries." BMJ open vol. 11,1 (2021): e042076. doi: https://doi.org/10.1136/bmjopen-2020-042076
Hoxha I, Zhubi E, Grezda K, Kryeziu B, Bunjaku J, Sadiku F, Agahi R, Lungu DA, Bonciani M, Little G. Caesarean sections in teaching hospitals: systematic review and meta-analysis of hospitals in 22 countries. BMJ Open. 2021 Jan 28;11(1):e042076. doi: 10.1136/bmjopen-2020-042076. PMID: 33509847; PMCID: PMC7845681.
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BMJ Open. 2021 Jan 28;11(1):e042076. doi: 10.1136/bmjopen-2020-042076.

Caesarean sections in teaching hospitals: systematic review and meta-analysis of hospitals in 22 countries.

BMJ open

Ilir Hoxha, Esra Zhubi, Krenare Grezda, Blerta Kryeziu, Jeta Bunjaku, Fitim Sadiku, Riaz Agahi, Daniel Adrian Lungu, Manila Bonciani, George Little

Affiliations

  1. Department of Community & Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA [email protected].
  2. Research Unit, Heimerer College, Prishtina, Kosovo.
  3. LifestylediagnostiX, Prishtina, Kosovo.
  4. Health and Management Laboratory (MeS Lab), Institute of Management and Department EMbeDS, Scuola Superiore Sant'Anna, Pisa, Italy.
  5. Department of Pediatrics and of Obstetrics and Gynecology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.

PMID: 33509847 PMCID: PMC7845681 DOI: 10.1136/bmjopen-2020-042076

Abstract

OBJECTIVE: The aim of this study is to determine the odds of caesarean section in all births in teaching hospitals as compared with non-teaching hospitals.

SETTING: Over 3600 teaching and non-teaching hospitals in 22 countries. We searched CINAHL, The Cochrane Library, PubMed, sciELO, Scopus and Web of Science from the beginning of records until May 2020.

PARTICIPANTS: Women at birth. Over 18.5 million births.

INTERVENTION: Caesarean section.

PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measures are the adjusted OR of caesarean section in a variety of teaching hospital comparisons. The secondary outcome is the crude OR of caesarean section in a variety of teaching hospital comparisons.

RESULTS: In adjusted analyses, we found that university hospitals have lower odds than non-teaching hospitals (OR=0.66, 95% CI 0.56 to 0.78) and other teaching hospitals (OR=0.46, 95% CI 0.24 to 0.89), and no significant difference with unspecified teaching status hospitals (OR=0.92, 95% CI 0.80 to 1.05, τ2=0.009). Other teaching hospitals had higher odds than non-teaching hospitals (OR=1.23, 95% CI 1.12 to 1.35). Comparison between unspecified teaching hospitals and non-teaching hospitals (OR=0.91, 95% CI 0.50 to 1.65, τ2=1.007) and unspecified hospitals (OR=0.95, 95% CI 0.76 to 1.20), τ2<0.001) showed no significant difference. While the main analysis in larger sized groups of analysed studies reveals no effect between hospitals, subgroup analyses show that teaching hospitals carry out fewer caesarean sections in several countries, for several study populations and population characteristics.

CONCLUSIONS: With smaller sample of participants and studies, in clearly defined hospitals categories under comparison, we see that university hospitals have lower odds for caesarean. With larger sample size and number of studies, as well as less clearly defined categories of hospitals, we see no significant difference in the likelihood of caesarean sections between teaching and non-teaching hospitals. Nevertheless, even in groups with no significant effect, teaching hospitals have a lower or higher likelihood of caesarean sections in several analysed subgroups. Therefore, we recommend a more precise examination of forces sustaining these trends.

PROSPERO REGISTRATION NUMBER: CRD42020158437.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Keywords: obstetrics; public health; statistics & research methods

Conflict of interest statement

Competing interests: None declared.

References

  1. J Perinat Med. 2007;35(4):282-8 - PubMed
  2. BMJ Open. 2017 Feb 17;7(2):e013670 - PubMed
  3. Am J Public Health. 1995 May;85(5):625-30 - PubMed
  4. Birth. 1994 Dec;21(4):194-6 - PubMed
  5. Am J Obstet Gynecol. 2010 Oct;203(4):326.e1-326.e10 - PubMed
  6. Matern Child Health J. 2005 Sep;9(3):307-16 - PubMed
  7. J Nurse Midwifery. 1994 Mar-Apr;39(2):91-7 - PubMed
  8. Matern Child Health J. 2017 Sep;21(9):1845-1852 - PubMed
  9. N Engl J Med. 1999 Jan 28;340(4):293-9 - PubMed
  10. BJOG. 2001 Sep;108(9):919-26 - PubMed
  11. Obstet Gynecol. 2001 Apr;97(4):567-76 - PubMed
  12. BMJ Open. 2019 Apr 11;9(4):e026702 - PubMed
  13. BMJ. 2000 Dec 16;321(7275):1501-5 - PubMed
  14. JAMA. 2017 May 23;317(20):2105-2113 - PubMed
  15. Control Clin Trials. 1986 Sep;7(3):177-88 - PubMed
  16. Lancet. 2018 Oct 13;392(10155):1341-1348 - PubMed
  17. Lancet Glob Health. 2015 May;3(5):e260-70 - PubMed
  18. Eur J Obstet Gynecol Reprod Biol. 2008 Dec;141(2):104-10 - PubMed
  19. Paediatr Perinat Epidemiol. 2009 Nov;23(6):574-81 - PubMed
  20. PLoS One. 2013;8(3):e57817 - PubMed
  21. Med Care. 2005 Mar;43(3):237-45 - PubMed
  22. Lancet. 2018 Apr 21;391(10130):1589-1598 - PubMed
  23. Acta Obstet Gynecol Scand. 2007;86(9):1071-8 - PubMed
  24. Iran J Public Health. 2016 Jun;45(6):768-73 - PubMed
  25. BMJ. 2007 Nov 17;335(7628):1025 - PubMed
  26. Obstet Gynecol. 2005 Mar;105(3):598-606 - PubMed
  27. BMJ Open. 2018 Oct 24;8(10):e022875 - PubMed
  28. BMC Pregnancy Childbirth. 2014 Jun 28;14:215 - PubMed
  29. Am J Obstet Gynecol. 2011 Oct;205(4):346.e1-4 - PubMed
  30. BMJ Open. 2019 Mar 3;9(3):e025356 - PubMed
  31. Eur J Obstet Gynecol Reprod Biol. 1995 Aug;61(2):129-34 - PubMed
  32. PLoS One. 2016 Jun 09;11(6):e0156172 - PubMed
  33. JAMA. 1991 Jan 2;265(1):59-63 - PubMed
  34. Milbank Q. 2002;80(3):569-93, v - PubMed
  35. Int J Gynaecol Obstet. 2016 Nov;135 Suppl 1:S51-S57 - PubMed
  36. J Surg Res. 2020 Jan;245:288-294 - PubMed
  37. BMC Pregnancy Childbirth. 2017 Jan 19;17(1):39 - PubMed
  38. BMJ Open. 2018 Mar 2;8(3):e019509 - PubMed
  39. PLoS Med. 2019 Feb 21;16(2):e1002742 - PubMed
  40. Eur J Obstet Gynecol Reprod Biol. 2007 May;132(1):27-34 - PubMed
  41. JAMA. 2000 Apr 19;283(15):2008-12 - PubMed
  42. Crit Care Med. 1993 Oct;21(10):1432-42 - PubMed
  43. Obstet Gynecol. 1996 Oct;88(4 Pt 1):530-3 - PubMed
  44. BMJ. 2009 Jul 21;339:b2535 - PubMed
  45. Am J Public Health. 1988 Sep;78(9):1170-4 - PubMed
  46. Med Care. 1985 Apr;23(4):283-95 - PubMed
  47. Health Policy. 2016 Jul;120(7):780-9 - PubMed
  48. Health Policy. 2016 Jun;120(6):596-603 - PubMed
  49. BJOG. 2016 Apr;123(5):667-70 - PubMed
  50. Health Serv Res. 1991 Aug;26(3):325-37 - PubMed
  51. PLoS One. 2018 Nov 28;13(11):e0207379 - PubMed
  52. Inquiry. 1987 Spring;24(1):68-84 - PubMed
  53. Rev Saude Publica. 2017 Mar 23;51(0):14 - PubMed
  54. J Perinatol. 2018 Feb;38(2):127-131 - PubMed
  55. Obstet Gynecol. 2002 Apr;99(4):577-80 - PubMed
  56. JAMA. 1993 Jun 23-30;269(24):3140-5 - PubMed
  57. Reprod Health. 2015 Jun 21;12:57 - PubMed
  58. Ann Surg. 2001 Sep;234(3):370-82; discussion 382-3 - PubMed
  59. Ann Intern Med. 2013 Feb 19;158(4):280-6 - PubMed
  60. Eur J Obstet Gynecol Reprod Biol. 2017 May;212:37-43 - PubMed
  61. BJOG. 2012 Nov;119(12):1483-92 - PubMed
  62. Health Serv Res. 2016 Oct;51(5):1879-95 - PubMed
  63. J Obstet Gynaecol Res. 2000 Oct;26(5):357-61 - PubMed
  64. Health Aff (Millwood). 1998 Nov-Dec;17(6):194-205 - PubMed
  65. BMJ Open. 2019 Apr 23;9(4):e024241 - PubMed
  66. Am J Obstet Gynecol. 2016 Apr;214(4):531.e1-531.e6 - PubMed
  67. Obstet Gynecol. 2020 Dec;136(6):1170-1178 - PubMed
  68. Eur J Obstet Gynecol Reprod Biol. 2008 Jan;136(1):46-52 - PubMed
  69. BMJ Open. 2017 Aug 21;7(8):e016600 - PubMed

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