Outcomes of cesarean sections performed by family physicians and the training they received: a 15-year retrospective study.
BACKGROUND
Family physicians are the major or sole providers of Cesarean section services in many communities. Approximately 2800 family physicians provide Cesarean section services in communities of all sizes across the country.


METHODS
The outcomes of all Cesarean sections performed at two rural hospitals during a 10- to 15-year period were examined and compared with standard quality-outcome criteria published in the medical literature. Outcome criteria included rates of various surgical complications, use of blood transfusion, infant Apgar scores, and length of postoperative hospital stay. Other descriptive data were examined including patient demographics, operating time, anesthesia type, and choice of incision. Statistical analysis consisted of chi-squares, odds ratios, and stepwise multiple regression.


RESULTS
Five hundred sixty-three Cesarean sections were performed by 12 residency-trained family physicians, 68 by general practitioners, 70 by general surgeons, and 9 by obstetrician-gynecologists. Family physicians met or surpassed the referenced standards in all measures examined. The number of Cesarean sections each physician performed while in residency training was also examined. The average number of in-training Cesarean sections was 46, ranging from 25 to 100.


CONCLUSIONS
The results of this study support the ability of family physicians to provide Cesarean section services based on a wide range of training backgrounds and variable numbers of procedures done in training.
Deutchman
M
M
Department of Family Medicine, University of Tennessee, Memphis, USA.
Connor
P
P
Gobbo
R
R
FitzSimmons
R
R
D002585:Cesarean Section; D003479:Curriculum; D005194:Family Practice / Q000193:education*; D005260:Female; D006780:Hospitals, Rural; D006801:Humans; D007231:Infant, Newborn; D007396:Internship and Residency; D007902:Length of Stay; D008485:Medical Audit; D009922:Oregon; D011183:Postoperative Complications / Q000209:etiology; D011247:Pregnancy; D018566:Pregnancy, High-Risk; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D016896:Treatment Outcome; D014861:Washington