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Are We Done Yet? A Study of Factors Influencing Cesarean Delivery Times
Abstract Number: F-04
Abstract Type: Original Research
Introduction: One of the most commonly asked questions by our patients is: “how long will surgery take?,” a question we sometimes ask ourselves in the midst of a case. We have previously reported the surgical time required for a primary (C1), secondary (C2), tertiary (C3) and quaternary or more (C4) CD.1 We now incorporate surgical factors (e.g., level of surgical training, details of the surgical procedure) into the analysis. Others have reported on factors affecting CD times 2,3, but these may differ by country/region and the nature of the institution.
Methods: This is a retrospective study of 1348 CDs performed from January to December 2011. Data was gathered from our electronic anesthesia records and EMR. We examined the effect of the number of previous CDs, age, gestational age (GA), BMI, trial of labor, urgency status, the anesthetic performed, the number of surgeons and surgeons’ experience, the layers and type of surgical closure, and the performance of tubal ligation (BTL) on skin to closure time. The effect of previous CDs was compared by ANOVA, with Scheffe’s post hoc test. A regression model was used to assess the combined effect of all independent variables, retaining those with p<0.05.
Results: There was a statistical difference between C1, C2 , C3, and C4 CDs when looking at skin to closure times (Table 1). Linear regression demonstrated that factors that affect surgical time were: BMI, GA, surgeons’ experience, number of layers closed, urgency status, and BTL. Results showed that having a PGY 1 or 2 level surgeon and an attending operate instead of two attending surgeons operate adds 14 min to the surgical time. These independent factors account for about 18% of the variance (Table 2).
Conclusion: There was a statistical difference in surgical time between a primary CD and repeat CD. C1 and C2 CDs are completed in mean times of 56 and 60 min, respectively. A single-shot spinal is an adequate anesthetic option for these cases. C3 and C4 CD mean times are 7 0 and 82 min, respectively; these cases may require prolonged neuraxial anesthesia. When taking in consideration the time for onset of anesthesia and surgical prepping, it is not unreasonable to perform a CSE for C3 and C4 CDs, especially if some of the factors shown to have a moderate impact on surgical times are present.
1. Abstract F22, SOAP 2013
2. Int J Obstet Anesth 2010
3. Aust N Z J Obstet Gynaecol 2008