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Individual Anesthesiologist Use of Regional Anesthesia for Cesarean Delivery in a Serbian Obstetric Hospital
Abstract Number: SA-43
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 its 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. This study looked at individual anesthesiologist differences in RA use for CS since the beginning of the Kybele/CCV partnership and if the prevalence of RA was related to the number of CS they performed.
Method: From the CCV delivery database for period 2011-2015, data on the use of general anesthesia (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 and the influence of the number of total cases performed by each anesthesiologist on their RA and GA use were determined. A logistic regression analysis was used to quantify the odds of RA versus GA use for CS overall, adjusting for year, elective and non-elective CS, and anesthesiologist. Appropriate adjustments for multiple comparisons were made.
Results: Total CS deliveries averaged 1964±94 per year (range 1779 – 2043). RA use increased from 20% in 2011 to 30% in 2015 among elective cases (p=0.002); from 5% in 2011 to 18% in non-elective cases (p<0.001). The increase in the use of RA was greater among non-elective cases versus elective procedures, over the interval 2011- 2015 (p=0.014) (Figure 1). There were significant differences in use of RA between anesthesiologists (p=0.003) and trajectory of use over time (p=0.008). There was no significant effect of total number of cases performed by anesthesiologist on RA use (p=0.109).
Conclusion: The use of RA between anesthesiologists varies widely, suggesting that more effort should be placed in the education of anesthesiologists in benefits/risks of RA among those with lower usage of RA and trend for use over time. The greater increase in RA use among non-elective cases was a surprising result, suggesting patient and obstetrician preference for GA might affect the choice of RA vs. GA more for elective CS than for non-elective CS.