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Comparative Maternal Risks Associated with General Anesthesia for Cesarean Delivery.
Abstract Number: O2-4
Abstract Type: Original Research
Compared with neuraxial anesthesia (NA), general anesthesia (GA) for cesarean delivery (CD) is associated with increased risks of death, cardiac arrest, anesthesia-related complications, surgical site infection, and postpartum hemorrhage (1-5). Risk for venous thromboembolic disease (VTE) is also suggested to be increased with GA. In addition, GA in obstetric patients is considered to have higher complications rates than in non-obstetric ones. However, quantification of GA risks with CD is imprecise and comparisons with non-obstetric patients non-existent. We sought to quantify the risks of GA for CD compared with NA for CD, and to perform a novel comparison between the risks of GA for CD and GA for total knee arthroscopy (TKA).
Using ICD-9-CM codes in the 2003-2014 New York State Inpatients Database (SID), the only SID providing data on anesthesia care, outcomes among women with CD and TKA under GA or NA were recorded. Adverse obstetric outcomes included death, cardiac arrest, anesthesia-related complications, postpartum hemorrhage, VTE, and surgical site infection. Using propensity score matching, 1 case of GA for CD was matched with 4 cases of NA. In matched patients, the risk of GA for CD compared with NA was quantified using the odds ratio from a conditional logistic regression. The risk of GA in CD relative to the risk of GA in TKA was quantified using the ratio of the incidence of the outcome in CD to the incidence in TKA.
Compared with NA, GA for CD was associated with increased risks for all examined outcomes (Table). The increase ranged from 1.2-fold for anesthesia-related complications to 4.7-fold for cardiac arrest. Compared with GA for TKA, risks associated with GA for CD were increased for all examined outcomes except for VTE. The increase ranged from 1.7-fold for death to 6.7-fold for surgical site infection.
GA for CD is associated with significantly increased risks of adverse outcomes compared with NA. We identified for the first time that GA for CD is associated with higher odds for complications than GA for TKA, despite these women being older and sicker. It emphasizes the need for judicious choice of the anesthetic technique for CD. In addition, GA is identified as a risk factor for VTE after CD, which is a novel finding.
1.Obstet Gynecol 2011;117:69-74.
3.Anesth Analg 2016;122:1947-56.
4.Br J Anaesth 2011;107:757-61.
5.Am J Obstet Gynecol 2011;205:462 e461-467.