More is Better: Cesarean Delivery Volume & Maternal Complications

Endless studies have analyzed the connection between the number of surgeries a surgeon performs and how well patients do after those surgeries. From knee replacements to hysterectomies, studies show that the more surgeries a surgeon performs, the better the outcomes. This association makes sense, of course. So does the relationship hold true for cesarean sections? As one of the most common surgeries performed, you might imagine that some researcher did this study decades ago. Surprisingly, until the July 2016 issue of the American Journal of Obstetrics and Gynecology, no one had ever studied the link between a surgeon’s annual cesarean delivery volume and mothers’ outcomes.

Doctors from the Shaare Zedek Medical Center and the Hadassah Medical Center in Jerusalem, Israel, reviewed the records of all the cesarean deliveries at one large hospital from 2006 to 2013: 11,954 cesarean deliveries in all. They counted up how many cesarean deliveries each attending doctor performed and then examined the medical records to see if moms had one or more maternal complications after their c-sections. Maternal complications included urinary or gastrointestinal tract injuries, drop in blood level (Hemoglobin lowered by >3), blood transfusion, need for a second surgery, fever, prolonged hospitalization, and readmission to the hospital. The researchers also recorded the operative times- the time it took from skin incision to delivery of the baby and the time for the whole surgery start to finish.

Obstetricians at the hospital performed a median of 48 cesarean deliveries per year. Obstetricians who performed 48 or more cesarean deliveries (the top half) had better outcomes.  Compared with the top 25% of obstetricians by surgery volume, the bottom 25% of obstetricians were 1.5 times more likely to have a complication. The top half of OBs by volume had fewer urinary and gastrointestinal tract injuries, less blood loss (measured by hemoglobin drop >3), and fewer cases of prolonged maternal hospitalization. Obstetricians who performed more or less cesarean deliveries had similar rates of their patients needing a blood transfusion, second surgery, or readmission.

Did the high volume and low volume surgeons show a difference in operative times? Yes. High volume obstetricians were significantly faster than low volume surgeons.

We want to hear from you! Expecting moms- how important is surgery volume to you when choosing your OBGYN? Obstetricians- do you keep track of your volume? Have you noticed any changes as you performed more surgeries over time?