Office hours and caesarean section: systematic review and Meta-analysis

Abstract

Abstract 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. Search strategy We searched CINAHL, ClinicalTrials.gov, The Cochrane Library, PubMed, Scopus and Web of Science from the beginning of records through August 2021. Data collection and analysis 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. Main 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. Funding The authors received no direct funding for this study.