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Assessment of Anesthesia Outcomes During Obstetric Hemorrhage
Abstract Number: F4A-3
Abstract Type: Original Research
Introduction: Obstetric hemorrhage is a life-threatening complication for which operative management is often required. Our aim in this study was to identify factors at the end of surgery that were potentially modifiable by the anesthesiologist, and to evaluate clinical outcomes as they relate to anesthetic intraoperative management of obstetric hemorrhage.
Methods: We reviewed all cases of obstetric hemorrhage from 2006 to 2016, selecting for those with a laparotomy for a primary hemorrhage, with or without hysterectomy. Only cases where the patient received intraoperative transfusion were included. We excluded cases which were returns to the operating room, dilation and curettage, or bleeding due to other factors such as known coagulopathy, amniotic fluid embolism, or sepsis. Demographic and obstetric data were added to data on anesthetic care. We also obtained outcomes data such as ICU admission, length of stay (LOS), and hospital charge. Unmodifiable factors (UMF) were out of the anesthesiologist’s control (hysterectomy, estimated blood loss, invasive placenta, etc.). Anesthetic outcome factors (AOF) were defined as potentially modifiable factors at the end of surgery (e.g. final hematocrit, systolic blood pressure, acid/base status, temperature, oxygenation, etc.). Univariate analysis was used to identify factors that were associated with LOS. Mixed model regression was used to identify AOF that were associated with LOS after controlling for UMF.
Results: 173 cases were included for analysis, including 40 invasive placentas, and 66 hysterectomies. On univariate analysis, most factors affected LOS were UMF (Table). Significant AOF included choice of anesthetic or conversion from regional to general anesthetic. Using regression analysis, only the number of transfused blood products (F-value=27.4, P<0.001) and the base deficit on blood gas analysis (F-value=8.0, P=0.006) were significant.
Discussion: After controlling for variables outside the control of the anesthesiologist, the only anesthetic outcome factors shown to be significant were transfusion volume and base deficit. Base deficit has been used in past as a signifier of poor tissue perfusion and has been associated with bad outcomes in emergency medicine and trauma surgery literature (1). This suggests that early arterial access allowing for frequent testing of base deficit may affect outcome, in addition to traditional resuscitation strategies.
1. Mutschler M et al Crit Care 2013;17: R42.