Caesarean sections in teaching hospitals: systematic review and meta-analysis of hospitals in 22 countries

作者：Ilir Hoxha, Esra Zhubi, Krenare Grezda, Blerta Kryeziu, Jeta Bunjaku, Fitim Sadiku, Riaz Agahi, Daniel Adrian Lungu, Manila Bonciani, George A. Little · 发表于：BMJ Open · 年份：2021 · DOI：10.1136/bmjopen-2020-042076 · 被引用次数：14 · 研究领域：Maternal and Perinatal Health Interventions、Female Genital Mutilation/Cutting Issues、Ureteral procedures and complications

OBJECTIVE: The aim of this study is to determine the odds of caesarean section in all births in teaching hospitals as compared with non-teaching hospitals. SETTING: Over 3600 teaching and non-teaching hospitals in 22 countries. We searched CINAHL, The Cochrane Library, PubMed, sciELO, Scopus and Web of Science from the beginning of records until May 2020. PARTICIPANTS: Women at birth. Over 18.5 million births. INTERVENTION: Caesarean section. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measures are the adjusted OR of caesarean section in a variety of teaching hospital comparisons. The secondary outcome is the crude OR of caesarean section in a variety of teaching hospital comparisons. RESULTS: In adjusted analyses, we found that university hospitals have lower odds than non-teaching hospitals (OR=0.66, 95% CI 0.56 to 0.78) and other teaching hospitals (OR=0.46, 95% CI 0.24 to 0.89), and no significant difference with unspecified teaching status hospitals (OR=0.92, 95% CI 0.80 to 1.05, τ2=0.009). Other teaching hospitals had higher odds than non-teaching hospitals (OR=1.23, 95% CI 1.12 to 1.35). Comparison between unspecified teaching hospitals and non-teaching hospitals (OR=0.91, 95% CI 0.50 to 1.65, τ2=1.007) and unspecified hospitals (OR=0.95, 95% CI 0.76 to 1.20), τ2<0.001) showed no significant difference. While the main analysis in larger sized groups of analysed studies reveals no effect between hospitals, subgroup analyses show that teaching hospitals c...