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Analysis of anaesthetic times for category 1 caesarean delivery: A 5-year review of outcomes.
Abstract Number: F-54
Abstract Type: Original Research
The Royal College of Obstetricians and Gynaecologists introduced a classification system for caesarean delivery (CD) in 2010. Category 1 CD describes immediate threat to life of the mother or fetus. Recommended times have been reported, but there is little data on anaesthetic times (defined as arrival to the operating theatre and surgery commencing) and neonatal outcomes for category 1 CD. We explored the relationship between level of anaesthetist, time of day and neonatal outcomes for category 1 CD performed over 5 years at our teaching hospital.
A retrospective analysis was performed of 3 prospective databases (anaesthetic, operating room and obstetric) between 2009-2014. The primary outcome for the study was anaesthetic time for category 1 CD and level of anaesthetist (consultant vs. trainee). Secondary outcomes were: relationship between anaesthetic time, time of day (‘day’=8am-8pm, with consultant presence; ‘night’ 8pm-8am with trainee on duty) and neonatal admissions to the neonatal unit (NNU). Statistical analysis was performed using R (R version 3.3.0 (2016-05-03). Time-to-event analysis was performed using Cox’s proportional hazards regression model.
The databases contained 59,333 independent data entries. For the primary and secondary outcomes 508 data entries were available. The type of anaesthetic provided for category 1 CD was 26% (n=133) general anaesthesia, 25% (n=131) spinal, 50% (n=255) epidural top-up. There was no difference in anaesthetic times between consultant anaesthetists and trainees (HR 0.788;95% confidence interval (CI) 0.612-1.017;p=0.0669). There was no variation in the number of CDs depending on time of day. CDs were performed faster at night (HR 1.259, 95% CI 1.107-1.431;p=0.0004). Anaesthetic times of category 1 CDs performed by trainees only did not however differ with time of day (HR 1.149, 95% CI 0.962-1.373;p = 0.123). Controlling for NNU admission, there was no difference in anaesthetic timings, regardless of time of day. The anaesthetic technique chosen by consultant vs. trainee was: Top-up:27 (39%) vs. 228 (45%); CSE:15 (22%) vs 29 (6%), Spinal:11 (16%) vs. 120 (24%); Epidural:1 (1%) vs. 7 (1%); GA:15 (22%) vs. 118 (23%), other:0 (0%) vs. 4 (1%), respectively.
There was no difference in anaesthetic time for category 1 CD when the anaesthetic was delivered by a consultant compared to a trainee. Category 1 CDs occurred evenly throughout a 24-hour period. Despite a faster anaesthetic time at night, admissions to the NNU were similar. All the CDs in this study were defined as category 1, although there are situations when the obstetrician may deem some category 1 CDs more urgent than others. Whilst we saw no impact of anaesthetic timings on neonatal outcome, this broad classification may obscure cases where changes in anaesthetic timings have an impact. Overall timings are quicker at night, this may occur due to a heavy bias from trainee led cases at night.