Use of a Standardized Algorithm to Decrease the Primary Cesarean Section Rate at a Major Tertiary Care Center [30B]

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INTRODUCTION: At Carolinas Medical Center, a standardized algorithm was implemented in 2015. The study purpose is to determine if this algorithm decreased the primary C-section rate for PC-02 patients. Subanalysis will determine if primary C-section rate varied by OB practice. Secondary analyses will examine BMI, race/ethnicity and scheduled vs unscheduled admissions. METHODS: Retrospective chart review compared PC-02 deliveries during 2014 vs 2015. We hypothesize implementing the algorithm decreased the primary C-section rate. Chi-square was used for statistical analyses. P value less than 0.05 was statistically significant. RESULTS: PC-02 deliveries totaled 2,152 in 2014 compared to 2,109 in 2015. In 2014, 516 patients underwent primary C-section (24.0%) vs 455 patients who underwent primary C-section in 2015 (21.6%). There were no significant differences between the 2014 and 2015 populations while comparing race/ethnicity (P=0.47), BMI (P=0.83), or scheduled (P=.50) vs unscheduled admissions (P=.13). After combining 2014 and 2015 data, C-section rates significantly varied by race/ethnicity (P < 0.0001). BMI was significantly higher in patients who underwent primary C-section (P < 0.0001). Scheduled admissions had a significantly higher primary C-section rate (27.3%) vs unscheduled admissions (19.8%) (P < .0001). CONCLUSION: The decrease in primary C-section rate in the PC-02 population showed a trend toward statistical significance after implementation of a standardized algorithm (P=.06). Staff OB had the lowest primary C-section rate (19.3%, P < .0001). After combining the data from 2014 and 2015, we noted several significant differences. We propose the current PC-02 criteria be expanded to include additional factors which may significantly influence the primary C-section rate.

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