Variation in Obstetric Intervention Rates across Hospitals in Sardinia

Episiotomy is one of the most widespread obstetric procedures but its practice highly varies among institutions and practitioners. The objective of this study is to assess the extent of variation in the use of episiotomy across hospitals and to evaluate how much of this variation can be explained by case-mix factors. Using data from hospital facilities located in the Italian region of Sardinia, we fit a multilevel logistic model which shows that almost half of the variation in episiotomy rates remains unexplained after conditioning on well-recognized indicators for episiotomy use and socio-demographic factors.