title: [C-section rate in low-risk women: a useful indicator to compare hospitals attending deliveries with different risks].
abstract: BACKGROUND
  the C-section rate has been criticized as a performance indicator for not considering that different hospitals manage deliveries with diverse risks. In this work we explore the characteristics of a new indicator restricted to low C-section risk deliveries.
  
  
  METHODS
  retrospective cohort of all births (n=214,611) in all public hospitals during 2005-2010 in the Valencia Region, Spain (source: minimum basic dataset). A low-risk subpopulation consisting of women under-35, no history of c-section, between 37 and 41 gestational weeks, and with a single fetus, with cephalic presentation and normal weight (2500-3999 g) was constructed. We analyzed variability in the new indicator, its correlation with the crude indicator and, using multilevel logistic regression models, the presence of residual risks.
  
  
  RESULTS
  a total of 117 589 births (58.4% of the whole deliveries) were identified as low C-section risk. The c-section rate in these women was 11.9% (24.4% for all deliveries) ranging between hospitals from 7.0% to 28.9%. The c-section rate in low-risk and total deliveries correlated strongly (r=0.88). The remaining risks in the population of low risk did not alter the hospital effect on the c-section rate.
  
  
  CONCLUSIONS
  the percentage of C-section in low risk women include a high volume of deliveries, correlated with the crude indicator and residual risks are not differentially influenced by hospitals, being a useful indicator for monitoring the quality of obstetric care in the National Health System.
authors.forename: Julián
authors.initials: J
authors.lastname: Librero
authors.forename: Salvador
authors.initials: S
authors.lastname: Peiró
authors.forename: Ana
authors.initials: A
authors.lastname: Belda
authors.forename: Julia
authors.initials: J
authors.lastname: Calabuig
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D002585:Cesarean Section / Q000706:statistics & numerical data* / Q000639:trends; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D004630:Emergencies / Q000453:epidemiology; D005260:Female; D006771:Hospitals, Maternity / Q000706:statistics & numerical data*; D006779:Hospitals, Public / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D011247:Pregnancy; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain; D019564:Unnecessary Procedures / Q000706:statistics & numerical data* / Q000639:trends