Variabilidad en la tasa de cesáreas entre hospitales públicos de Costa Rica

Abstract

Background: The cesarean rate is a multidimensional indicator very used in the performance hospital analysis because it includes aspects of adequacy of care, patient safety and efficiency in resource utilization. Objective: To determine the rates and variability in cesarean delivery care among Costa Rica public hospitals. Methods: We used data of births from the period 2010-2011 to calculate rates of cesarean in total and low-risk deliveries. Proportions and its confidence intervals were estimated to determine which hospitals are significantly away of cesarean optimal range recommended by WHO and variation ranges were calculated for both cesarean rates and the average stay of obstetrical procedures. Results: The cesarean rate in total deliveries was 19.4% and 18.6% in low-risk deliveries. Half of hospitals registered cesarean rates outside of the range recommended by WHO (10-15%). There is high variability in the rate of cesarean section between hospitals and moderate variability in the length of stay in the processes of cesarean and vaginal delivery with complications. Conclusion: The differences in the severity of the patients did not significantly influence the variability of cesarean rate, because hospitals with a high incidence of low-risk cesarean also have high rates on the rest of deliveries.