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2018 Abstract Details2019-08-02T15:57:01-05:00

Predictors for Women Who Are Not 100% Satisfied with Obstetric Anesthesia Care after Vaginal Delivery and Cesarean Delivery: A Retrospective Cohort Study

Abstract Number: F4B-6
Abstract Type: Original Research

Mary Yurashevich MD, MPH1 ; Brendan Carvalho MBBCh, FRCA, MDCH2; Alexander J. Butwick MBBS, FRCA, MS3; Kazuo Ando MD, PhD4; Pamela D. Flood MD, MA5

Introduction: Patient's satisfaction is an important goal in obstetric anesthesia care that contributes to maternal wellbeing. Variables associated with satisfaction with obstetrical anesthesia care are uncertain, and identifying areas that contribute to dissatisfaction are key to improving quality of care (1,2). We sought to identify predictors for those who were not 100% satisfied with their obstetric anesthesia care.

Methods: 4297 patients who had labor analgesia or cesarean anesthesia provided satisfaction data at 24 hr post-vaginal delivery and 48 hr post-cesarean delivery. Because 78% of patients were 100% satisfied, we classified satisfaction as 100% satisfied or less than 100% satisfied (defined as dissatisfied). We considered demographic and intrapartum factors, delivery mode, pain scores, anesthetic-related adverse effects, and delay in receiving neuraxial labor analgesia as potential candidate variables for those dissatisfied. Multivariable modeling was done with sequential logistic regression in R.

Results: For vaginal delivery (Figure 1a), multivariate analysis revealed that pain after epidural, during second stage and postpartum were significant predictors of maternal dissatisfaction (P=2e-11, 2e-6, 5e-4 respectively). Postpartum headache, pruritus and wait time for labor epidural >15 minutes contributed to dissatisfaction (P=3e-5, 0.005, 2e-10 respectively). Non-Hispanic ethnicity was slightly predictive of dissatisfaction (P=0.01). For cesarean delivery (Figure 1b), intensity of post-partum pain, headache and pruritus also predicted dissatisfaction (P=1e-6, 0.001, 0.001 respectively). Hispanic ethnicity was also protective against dissatisfaction (P=0.005).

Conclusion:

Inadequate pain control and treatment-related side effects contribute to maternal dissatisfaction, and development of protocols that provide an appropriate balance between analgesic efficacy and side effects is an important target to minimize maternal dissatisfaction. Providing rapid responses to labor epidural requests and appreciating ethnic differences in maternal satisfaction with obstetric anesthesia care are highlighted by this analysis.

References:

1. J Hosp Med 2015;10(8):497-502

2. BMJ Open 2014;4(2):e004013



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