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Temporal Trends in Anesthesia-related Adverse Events in Cesarean Deliveries in New York State, 2003-2012
Abstract Number: S-33
Abstract Type: Original Research
Background: Cesarean delivery (CD) is associated with significantly increased risk of anesthesia-related adverse events (ARAEs), non-anesthetic perioperative complications (NAPCs), and mortality compared with vaginal delivery (Deneux-Tharaux et al. Obstet Gynecol 2006; 108:541-8). Temporal trends in these adverse outcomes remain unknown despite efforts of anesthesiologists to improve maternal safety. This study examines temporal trends in ARAEs, NAPCs, and mortality in CDs in New York State between 2003 and 2012.
Methods: Data are from the State Inpatient Database (SID) for New York from 2003 to 2012. ARAEs and NAPCs (myocardial infarction, heart failure, respiratory failure, venous thromboembolic disease, disseminated intravascular coagulation, renal failure, sepsis, and stroke) were identified through International Classification of Diseases, Ninth Revision, Clinical Modification codes. Death was recorded directly from SID data. The annual rates of ARAEs were analyzed according to the type of CD (planned or unplanned), the type of anesthesia (general or non-general), and 3 hospital characteristics: annual volume of CDs (low-, intermediate- or high-volume hospital), presence of a residency program (yes or no) and location (urban or rural). Adjusted logistic regression was used to assess the statistical significance of changes in rates.
Results: Of the 785,854 CDs studied, 362,192 (46.0%) were planned, 5,715 (7.3/1,000) had at least one ARAE, and 7,040 at least one NAPC (8.9/1,000); 179 maternal deaths were recorded (0.2/1,000). The annual rate of ARAE decreased from 8.9/1,000 in 2003 to 6.6/1,000 in 2012 (-26%, P < 0.0001) (Figure 1A), regardless of the type of CD and the 3 hospital characteristics. There was no decrease in the rate of ARAEs in CDs performed under general anesthesia (10.7/1,000 in 2003 and 11.0/1,000 in 2012; P = 0.68) but a decrease was observed in CDs performed under non-general anesthesia (from 8.7/1,000 in 2003 to 6.5/1,000 in 2012; -25%; P < 0.0001). The rate of NAPCs increased by 47% (P < 0.0001) (Figure 1B) and overall mortality decreased by 51% (P < 0.0001).
Conclusions: Anesthesia-related outcomes in CDs appear to have improved significantly across hospitals in New York State in the past decade but NAPCs remain a serious healthcare issue. Further options to increase the safety of general anesthesia should be explored.