G. A. Del Carmen1, S. Stapleton1, M. Qadan1, D. Chang1, Y. Bababekov1, B. Zhang1, Y. Hung1, Z. Fong1, M. G. Del Carmen1 1Massachusetts General Hospital,Department Of Surgery,Boston, MA, USA
Introduction: While guidelines for clinical indications of Cesarean sections (CS) exist, non-clinical factors may affect CS practices. We hypothesize that CS rates vary by day of the week.
Methods: An analysis of the Office of Statewide Health Planning and Development database for California from 2006-2010 was performed. All female patients admitted to a hospital for attempted vaginal deliveries were included. Patients who died within 24 hours of admission were also excluded. Weekend days were defined as Saturday and Sunday; weekdays were defined as Monday through Friday. The primary outcome was rates of CS relative to vaginal delivery. Multivariate regression was performed, adjusting for patient demographic, clinical, and system factors.
Results: 1,855,675 women were analyzed. Overall CS rates were 9.02%. On unadjusted analysis, CS rates were significantly lower on weekends than on weekdays (6.65% vs. 9.58%, p<0.001). On adjusted analysis, women were 27% less likely to have a CS on weekends than on weekdays (OR: 0.73, 95% CI 0.71-0.75, p<0.001). In addition, Hispanic ethnicity and delivery in a teaching hospital were also associated with a decreased likelihood of CS (OR 0.91, 95% CI 0.86-0.96, p=0.01; OR 0.80, 95% CI 0.69-0.93, p <0.001, respectively).
Conclusion: CS rates are significantly decreased on weekends relative to weekdays, even when controlling patient, hospital, and system factors. Further exploration of this novel finding is warranted and will lead to improved quality of care for patients.
