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Do obstetric anesthesiologists provide more guideline-concordant care for patients undergoing cesarean delivery?
Abstract Number: F3A-3
Abstract Type: Original Research
Current practice guidelines for obstetric anesthesia recommend neuraxial anesthesia for cesarean delivery in most patients. Nonetheless, little is known about how anesthesiologist specialization in obstetric anesthesia impacts patients’ likelihood of receiving general anesthesia for cesarean delivery. We conducted a retrospective cohort study to compare utilization of general anesthesia for cesarean delivery among patients treated by obstetric-specialized versus generalist anesthesiologists.
We studied patients undergoing cesarean delivery for live singleton pregnancies between July 2013 and March 2017 at an urban hospital. Data was extracted from the electronic medical record and via manual chart review. The primary outcome was receipt of general anesthesia for cesarean delivery. The primary exposure was anesthesiologist specialization in obstetric anesthesia, defined as completing a fellowship in obstetric anesthesiology or having commensurate experience, as determined by the division of obstetric anesthesiology. We carried out unadjusted comparisons using standard bivariate hypothesis tests; multivariable logistic regression was used to estimate the association of anesthesiologist specialization with the odds of general anesthesia while holding patient factors constant. We compared the fraction of general anesthetics for cesarean delivery that were preceded by an attempt at neuraxial anesthesia between provider types using bivariate statistics.
Our study sample included 4,052 cesarean deliveries; 2,717 (63%) were performed by obstetric-specialized anesthesiologists and 1,335 (27%) were performed by generalist anesthesiologists. General anesthesia was used in 8.9% (n=363) of cases, and the rate of general anesthesia differed between obstetric-specialized and generalist anesthesiologists (7.3% vs 12.4%, p=0.001). After adjustment for patient age, race, parity, gestational age, cesarean delivery urgency and indication, treatment on maternal fetal medicine service, and hypertension/preeclampsia, the odds of general anesthesia usage were lower among patients treated by obstetric-specialized vs. generalist anesthesiologists among all cesarean delivery patients (OR 0.63, 95% CI 0.49-0.81, p=0.001), and in a subgroup analysis restricted to patients undergoing urgent or emergent cesarean delivery only (OR 0.65, 95% CI 0.50-0.86, p=0.003). Overall, patients that received general anesthesia for cesarean delivery were more likely to have a neuraxial block attempted before general anesthesia induction if treated by an obstetric-specialized anesthesiologist (28% vs. 17%, p=0.014).
Treatment by an obstetric-specialized anesthesiologist is associated with lower odds of general anesthesia usage for cesarean delivery.
1.Practice Guidelines for Obstetric Anesthesia: An Updated Report by the American Society of Anesthesiologists and Society for Obstetric Anesthesia and Perinatology. Anesthesiology 2016.