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Does Socioeconomic Status Predict Anesthesia Type for Cesarean Sections?
Abstract Number: SAT-10
Abstract Type: Original Research
General anesthesia for Cesarean section (GACS) is often used as “back-up” anesthesia because GACS prevents a parturient’s participation in delivery and risks failed intubation. For this reason, neuraxial anesthesia for Cesarean section (NACS) is used primarily. Maternal comorbid factors have clearly been defined as risk factors for GACS, but maternal socioeconomic status (SES) has not. The aim of this research is to identify maternal markers of SES that are risk factors for GACS.
We performed a case-control study to evaluate if SES markers are associated with increased risk of GACS. We reviewed all Cesarean sections (CS) performed at our major university hospital between July 2013 and June 2016. Cases were patients receiving GACS and controls were patients that underwent CS with neuraxial (spinal and epidural) anesthesia. SES markers extracted from health records included race/ethnicity, marital status, smoking status, and practice location for prenatal care. We excluded patients with multi-gestational pregnancy, intraoperative fetal demise, or missing exposure data. We used chi-square to compare exposure variables between cases and controls. We used logistic regression to generate odds ratios (OR) of each exposure variable in relation to GACS. p-value <0.05 was considered significant.
Among a total of 3,417 CS included in our study, GACS (cases) accounted for 9.1% of subjects and NACS (controls) accounted for 90.9% of subjects. Racial and ethnic percentages of subjects were Black (65.1%), White (19.8%), Asian (6.2%), other (5.8%), and Hispanic (3.0%). No differences were found between the cases and controls regarding age and ASA status. Using univariate logistic regression, the SES risk-factors for GACS were black race (OR=1.7, 95% CI 1.29-2.2), smoking status (OR= 1.47, 95% CI 1.13-1.91), single marital status (OR= 1.68, 95% CI 1.28-2.20), low-income prenatal care practice (OR=1.61, 95% CI 1.24-2.09), and outside care network prenatal care (OR=2.23, 95% CI 1.48-3.27). After using multivariate logistic regression, only black race (aOR=1.58, 95% CI 1.11-2.23) and current smoking status (aOR=1.53, 95% CI 1.17-1.99) remained statistically significant (p<0.05).
Black race and current smoking status are associated with higher use of GACS. Further research is needed to understand how maternal socioeconomic status may influence anesthetic choice for Cesarean section.