THE PHYSICIAN FACTOR IN CESAREAN BIRTH-RATES
THE PHYSICIAN FACTOR IN CESAREAN BIRTH-RATES
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DOI：
10.1056/nejm198903163201106
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发表时间：
1989-03-16
影响因子：
158.5
通讯作者：
NEHRA, PC
中科院分区：
文献类型：
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作者：
GOYERT, GL;BOTTOMS, SF;NEHRA, PC
为了探讨医生的执业方式对剖宫产率的影响，我们研究了1533名产科并发症低风险的富裕妇女，她们在一家社区医院接受了11名产科医生的护理。据医生说，剖宫产的平均比率为26.9%，但比率范围从19.1%到42.3%不等。初次剖宫产的平均率（即，以前没有剖腹产的妇女的比率为17.2%，范围为9.6%至31.8%。初次剖宫产的决定因素包括医生、产次、出生体重和母亲年龄，排除特殊的医学指征，逐步Logistic回归模型显示，在对剖宫产率的影响中，只有未经产次（P <0.001）比医生的身份（P <0.001）更重要。医生之间剖腹产率的差异与实践环境、患者人群、产科风险程度或医生最近的法医学经验无关，也不伴随新生儿结局的相应差异。我们的结论是，个人的实践风格可能是一个重要的决定因素，在产科医生之间的剖宫产率的广泛变化。我们的数据不允许我们肯定地说，是否该程序是过度使用的一些产科医生或未充分使用的其他人，但我们没有发现明显的差异，新生儿的结局与剖宫产率的差异。
To investigate the influence of physicians'' practice styles on the rate of deliveries by cesarean section, we studied 1533 affluent women at low risk of obstrical complications who were cared for by 11 obstetricians in a single community hospital. The mean rate of delivery by cesarean section was 26.9 percent, but the rate ranged from 19.1 to 42.3 percent, according to physician. The mean rate of primary cesarean section (i.e., the rate for women without previous cesarean deliveries) was 17.2, with a range of 9.6 to 31.8 percent. A stepwise logistic-regression model of the determinants of primary cesarean section, including the individual physician, parity, birth weight, and maternal age and excluding specific medical indications, showed tht only nulliparity (P < 0.001) was more important than the identity of the physician (P < 0.001) in its influence on the rate of cesarean section. Variation in cesarean-section rates among physicians was not atttributable to the practice setting, the patient population, the degree of obstetrical risk, or the physician''s recent medicolegal experience, and it was not accompanied by corresponding differences in neonatal outcome. We conclude that individual practice style may be an important determinant of the wide variations in the rates of cesarean delivery among obstetricians. Our data do not permit us to say with certainty whether the procedure is overused by some obstetricians or underused by others, but we found no obvious differences in neonatal outcome associated with differences in the cesarean-section rate.