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Obstetric Anesthesia Clinics: A survey of Academic Centers in the United States
Abstract Number: S-60
Abstract Type: Original Research
The anesthetic management of high-risk obstetric patients is often challenging. Knowledge of patients’ pre-existing morbidities and functional status is important in tailoring anesthetic and interdisciplinary plans for labor and delivery. An obstetric anesthesia clinic (OAC) can provide an ideal venue for facilitating anesthetic pre-delivery planning, (1) however, the adoption of OACs in contemporary anesthetic practice is uncertain. Our study aim was to examine the use and characteristics of OACs in US academic hospitals.
We identified US academic hospitals with ACGME accredited anesthesia residency programs (www.acgme.org). For each hospital, the obstetric anesthesia director was contacted by email and invited to complete an online survey. In the survey specific questions were asked about the operational characteristics of the OAC, if present, within each institution. Data are presented as median [IQR], n(%). Categorical data were analyzed using Fisher’s test: P<0.05 as statistically significant.
113 obstetric anesthesia directors were contacted and 65 directors completed the survey (response rate=58%). L&D units were categorized into three groups (tertiles) according to delivery volume: low, medium and high volume = 1800 [1500-2000], 3000 [2500-3500], and 4500 [3950-7000] deliveries per year respectively (Table). Overall, only 38% hospitals had an OAC. The proportion of hospitals with an OAC and the operational hours of the OACs did not vary by delivery volume. OACs were generally staffed by anesthesiologists, with residents involved in over half the OACs. Disappointedly, the directors reported that obstetricians did not always refer high-risk patients to the OAC; the frequency of OAC referral by obstetricians was inconsistent. None of the directors indicated that obstetricians ‘always’ referred patients to the OAC, with 44% directors reporting that obstetricians ‘never’ referred patients.
In this survey, less than half of all academic hospitals had an OAC. Although organizational characteristics of an OAC were inconsistent, these were not influenced by hospital delivery volume. Future studies are needed to determine whether implementation of an OAC improves the anesthetic management and peripartum outcomes of high-risk patients..
References: (1) SOAP Summer Newsletter 2014