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Impact of Anesthesiologist’s Fellowship Status and Experience on the Risk of General Anesthesia for Cesarean Delivery in Patients Receiving Labor Epidural Analgesia
Abstract Number: F3A-5
Abstract Type: Original Research
Neuraxial analgesia is preferred over general anesthesia for cesarean delivery, particularly in the presence of an indwelling labor epidural catheter. Care by a non-obstetric anesthesiologist has been proposed as a risk factor for use of general anesthesia in this patient population. In a meta-analysis by Bauer et al1, care by a non-obstetric anesthesiologist was found to be the only significant modifiable risk factor for failed conversion of epidural labor analgesia to surgical anesthesia. However, care by a non-obstetric anesthesiologist was addressed in only two of the thirteen studies included in their final analysis and no studies indicated fellowship-training status of the anesthesiologist as a primary outcome.2,3
To determine whether fellowship status of the covering anesthesiologist was a risk factor for general anesthesia, we retrospectively investigated the rate of general anesthesia use in patients with epidural catheters placed for labor analgesia who subsequently required cesarean delivery. To standardize the practice environment under which these cases occurred, we examined only cases which occurred during coverage by the call team on nights, weekends and holidays.
There were 1,820 cases in which a patient had an epidural labor analgesia followed by a cesarean delivery. 912 cases were covered by an obstetric anesthesiologist and 908 cases were covered by a non-obstetric anesthesiologist. General anesthesia was used in only 16 of these cases. General anesthesia was more likely to be performed by non-obstetric fellowship trained anesthesiologists (1.54% or 14/16 compared to 0.22% or 2/16; p = 0.002). Obstetric fellowship trained anesthesiologists were more likely to be more years out of residency (19.3 years compared to 6.3 years; p<0.001).
In univariate logistic regression, OB trained attending anesthesiologists demonstrated an 86% decreased odds of ELA-GA compared to Non-OB trained attending anesthesiologists (OR= 0.14, 95% CI 0.03 - 0.62; p=0.010). Univariate regression also demonstrated a 7% decreased odds of ELA-GA for every additional year out of residency (OR=0.93, 95% CI= 0.87 - 1.00; p=0.038).
This investigation suggests that the presence of an obstetric fellowship-trained anesthesiologist is a predictor of decreased rate of general anesthesia use in patients with preexisting indwelling labor epidural catheters. Our data, analyzed with univariate logistic regression, suggest that staffing with OB fellowship trained anesthesiologist may serve as a practice model that reduces the risk of general anesthesia.
1. Bauer, ME. Int J Obstet Anesth, 2012. 21(4): p. 294-309.
2. Campbell, DC. Can J Anaesth, 2009. 56(1): p. 19-26.
3. Riley, ET. Int J Obstet Anesth, 2002. 11(2): p. 81-4.