背景:不必要的剖腹产可能受到医生因素的影响,比如偏好,激励和便利。办公时间内的交付可能是衡量此类影响的有价值的代理。
目的:通过评估办公时间内剖腹产与非办公时间相比的几率,来确定办公时间对剖腹产决定的影响。
方法:我们搜索了CINAHL,ClinicalTrials.gov,科克伦图书馆,PubMed,Scopus和WebofScience从记录开始到2021年8月。
方法:搜索结果由三名研究人员筛选。首先,我们选择了报告剖腹产比值比的研究,或者允许他们计算的数据,办公室和非办公时间。我们提取了研究人群的数据,研究设计,数据源,设置,剖腹产的类型,统计分析,和结果措施。对于报告相同结果的组,我们进行了标准的逆方差随机效应荟萃分析,这使我们能够计算每个组的总体赔率比。对于报告不同结果的小组,我们进行了描述性分析.
结果:任何剖腹产的工作日与周末的荟萃分析显示,在调整分析1.40中,工作日剖腹产的几率更高(95CI1.13,1.72来自1,952,691例分娩)。在工作日与周日比较中观察到类似的效果(1.39,95CI1.10,1.75,150,932个出生)。对于急诊CS观察到较低的效果,调整后分析略有增加(1.06,95CI0.90,1.26,2,622,772例),未调整分析略有增加(1.15,95CI1.03,1.29,12,591,485例)。在亚组分析和研究其他办公时间结果的描述性综合中观察到类似的趋势。
结论:在办公时间分娩与整体剖腹产的几率较高相关,对紧急剖腹产的影响很小甚至没有。与办公时间相关的非临床因素可能会影响剖腹产的决定。对分娩护理中的“办公时间效应”进行进一步详细调查是必要的,并可能导致护理系统的改进。
背景:作者没有获得这项研究的直接资助。
BACKGROUND: Unnecessary caesarean births may be affected by physician factors, such as preferences, incentives and convenience. Delivery during office hours can be a valuable proxy for measuring such effects.
OBJECTIVE: To determine the effect of office hours on the decision for caesarean delivery by assessing the odds of caesarean during office hours compared to out-of-office hours.
METHODS: We searched CINAHL, ClinicalTrials.gov , The Cochrane Library, PubMed, Scopus and Web of Science from the beginning of records through August 2021.
METHODS: Search results were screened by three researchers. First, we selected studies that reported odds ratios of caesareans, or data allowing their calculation, for office and out-of-office hours. We extracted data on the study population, study design, data sources, setting, type of caesarean section, statistical analysis, and outcome measures. For groups reporting the same outcome, we performed a standard inverse-variance random-effects meta-analysis, which enabled us to calculate the overall odds ratios for each group. For groups reporting varying outcomes, we performed descriptive analysis.
RESULTS: Meta-analysis of weekday vs weekend for any caesarean section showed higher odds of caesarean during weekdays in adjusted analysis 1.40 (95%CI 1.13, 1.72 from 1,952,691 births). A similar effect was observed in the weekday vs Sunday comparison (1.39, 95%CI 1.10, 1.75, 150,932 births). A lower effect was observed for emergency CS, with a slight increase in adjusted analysis (1.06, 95%CI 0.90, 1.26, 2,622,772 births) and a slightly higher increase in unadjusted analysis (1.15, 95%CI 1.03, 1.29, 12,591,485 births). Similar trends were observed in subgroup analyses and descriptive synthesis of studies examining other office hours outcomes.
CONCLUSIONS: Delivery during office hours is associated with higher odds for overall caesarean sections and little to no effect for emergency caesarean. Non-clinical factors associated with office hours may influence the decision to deliver by caesarean section. Further detailed investigation of the \"office hours effect\" in delivery care is necessary and could lead to improvements in care systems.
BACKGROUND: The authors received no direct funding for this study.