///2009 Abstract Details
2009 Abstract Details2018-05-01T17:45:11+00:00

Factors Impacting Cesarean Delivery Operative Times

Abstract Number: 200
Abstract Type: Original Research

Sylvia Wilson M.D.1 ; Julie Marshall M.D.2; Karamarie Fecho Ph.D.3; Fred Spielman M.D.4

INTRODUCTION

The ability to predict the length of a cesarean delivery is crucial in determining the optimal anesthetic. Anticipation of a long operative time might require an epidural or combined spinal-epidural anesthetic rather than a spinal to avoid conversion to a general anesthetic. We present the first prospective study to examine multiple patient and surgical factors that influence the length of cesarean deliveries.

METHODS

An IRB-approved, prospective, observational study was conducted on 332 subjects undergoing elective, non-emergent cesarean sections by a low transverse skin and uterine incision. Patients with prior abdominal surgery were excluded. Data were collected on the time of skin incision, uterine incision and skin closure. Total operative time was defined as skin closure minus skin incision (minutesSD). Data also were collected on race (White, Black, Hispanic, other), surgeon seniority (attending vs. other), number of prior cesarean sections, years since the last cesarean section (<3 vs. >3), age (<30 vs. >30 years), height, weight and performance of a tubal ligation (yes or no). BMI was calculated (kg/m2) and categorized as obese (BMI>30) or morbidly obese (BMI>35) or not. Severity of stretch marks and skin scarring were rated using a 1 (minimal) to 10 (severe) scale and a median split was used to categorize the ratings into <3 or >3. The data were analyzed using an Analysis of Variance or Chi Square test, with α=0.05.

RESULTS

Overall, total operative times ranged from 9 to 108 minutes, with a mean of 4315 minutes. Total operative time increased linearly as number of prior cesarean sections increased (p<0.0005), from 3913 minutes in subjects without a prior cesarean section, to 5218 minutes in subjects with 3 or more prior cesarean sections. Operative time also was significantly longer in subjects with a scar score >3 versus those with a scar score <3 (4716 vs. 4015 minutes; p<0.005). Attending surgeons had greater total operative times than junior surgeons (4516 vs. 3913 minutes; p<0.01). Attendings also more frequently worked with senior residents and fellows (18.4% vs. 5.9%; p<0.02) and on older subjects (59.4% vs. 48.3%; p<0.07). Tubal ligation prolonged the total operative time (4816 vs. 4114 minutes; p <0.0005). Total operative time did not vary by age, ethnicity, obesity, morbid obesity, years since last cesarean section, or stretch mark score.

DISCUSSION

Our findings identify multiple prior cesarean sections, increased scar intensity, and tubal ligation as factors that may influence operative times for cesarean delivery. We suggest that a continuous anesthetic technique be used in patients with a history of 3 or more prior cesarean sections. Increased operative times for attending surgeons likely reflects their involvement with more difficult cases. Obesity did not prolong cesarean delivery times, but an effect of obesity might have been obscured by the fact that 2/3 of parturients were obese.

SOAP 2009