SynthesisBMJ open2021
Caesarean sections in teaching hospitals: systematic review and meta-analysis of hospitals in 22 countries.
Synthesis in BMJ open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
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Who cites it
6 citing papers in PubMed, 11 citations in OpenAlex.
- Exploring the influence of medical staffing and birth volume on observed-to-expected cesarean deliveries: a panel data analysis of integrated obstetric and gynecological departments in Germany.The European journal of health economics : HEPAC : health economics in prevention and care · 2025Article
- How cesarean section rates can be reduced through an effective financial strategy: A protocol for systematic review.Medicine · 2025Article
- The influence of emotional labor and emotional intelligence on cesarean section decision-making among midwives and obstetricians in Kosovo: A cross-sectional study using conjoint analysis.European journal of midwifery · 2025Article
- Staff Resources in Public and Private Hospitals and Their Implication for Medical Practice: A French Study of Caesareans.Healthcare (Basel, Switzerland) · 2024Article
- Article
- Office hours and caesarean section: systematic review and Meta-analysis.Research in health services & regions · 2022Review
Corrections and comments
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Authors and funding
10 authors at 3 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveThe aim of this study is to determine the odds of caesarean section in all births in teaching hospitals as compared with non-teaching hospitals.
settingOver 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.
participantsWomen at birth. Over 18.5 million births.
interventionCaesarean 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.
resultsIn 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 carry out fewer caesarean sections in several countries, for several study populations and population characteristics.
conclusionsWith smaller sample of participants and studies, in clearly defined hospitals categories under comparison, we see that university hospitals have lower odds for caesarean. With larger sample size and number of studies, as well as less clearly defined categories of hospitals, we see no significant difference in the likelihood of caesarean sections between teaching and non-teaching hospitals. Nevertheless, even in groups with no significant effect, teaching hospitals have a lower or higher likelihood of caesarean sections in several analysed subgroups. Therefore, we recommend a more precise examination of forces sustaining these trends. PROSPERO REGISTRATION NUMBER: CRD42020158437.
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