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The Influence of an Individual Obstetrician on the Use of Regional Anesthesia for Cesarean Section in a Serbian Obstetric Hospital
Abstract Number: SA-41
Abstract Type: Original Research
Introduction: In Serbia, the use of regional anesthesia (RA) and analgesia techniques in obstetrics has been low, despite local efforts to increase the use. Members of the Department of Anesthesia at Clinical Center, Vojvodina (CCV), requested a multi-year Kybele program in 2012 to help train physicians in the use of RA techniques for labor and cesarean section (CS). CCV is large obstetric hospital with approximately 6500 deliveries per year. In order for CCV to become recognized as a leading facility in obstetric anesthesia, the use of RA techniques must increase. We looked at the factors that may be influencing choice of anesthesia for CS including individual obstetrician differences in RA use for CS, and whether the prevalence of their RA use was related to their total CSs.
Method: From the CCV delivery database for period 2011-2015 data on the use of general (GA) and RA for elective and non-elective CS were obtained. Differences in the use of RA for elective and non-elective cases between individual practitioners were determined and the influence of the number of total cases performed by each on RA and GA use. A logistic regression analysis was used to quantify the ratio of RA to CS overall, adjusting for year, elective and non-elective CS, and obstetrician. Appropriate adjustments for multiple comparisons were made.
Results: During the study period, data were available for 9808 procedures, for 48 obstetricians. RA use increased among elective cases from 20% in 2011 to 30% in 2015 (p=0.002); from 5% in 2011 to 18% in non-elective cases (p<0.001). There was no significant effect of total number of cases performed by an obstetrician on their use of RA (p=0.109). There were marginally statistically significant differences among obstetricians in overall prevalence of RA use (p=0.091) and in rate of change over time (p=0.068). Due to the large number of obstetricians, graphs include only those who did more than 250 procedures during the evaluation period (Figure 1).
Conclusion: Although no differences in RA use could be determined among all 48 obstetricians included in the analysis, the results can be used to target education effort to obstetrician staff at CCV on use of RA among those who perform the largest number of CS. The use of RA between obstetricians varies widely, suggesting that more effort should be placed in education of use of RA in obstetricians with lower usage of RA.