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

Patient- and Hospital-Level Factors Associated with the Use of General Anesthesia for Cesarean Delivery.

Abstract Number: T2B-3
Abstract Type: Original Research

Jean Guglielminotti M.D., Ph.D.1 ; Ruth Landau M.D.2; Guohua Li M.D., Dr. P.H.3

Background

Compared with neuraxial anesthesia (NA), general anesthesia (GA) for cesarean delivery (CD) is associated with increased risk of adverse maternal outcomes. GA is provided in 5.5 % of CDs (1). Characterizing factors associated with the use of GA may identify targets to reduce CDs under GA and improve maternal safety. To date, research has focused on patient-level factors associated with the use of GA (e.g., women comorbidities) (2). However, hospital-level factors could also be targets. Indeed, higher GA use is suggested in teaching hospitals (1). This study aimed to characterize all hospital-level factors associated with the use of GA for CD.

Methods

Patient-and hospital-level factors and GA for CD were identified in the 2003-2014 New York State Inpatients Database (SID) and the American Hospital Association file. New York is the only SID providing data on anesthesia care. Hospital-level factors included 13 variables encompassing structural characteristics, staffing, and case-mix. Multilevel modeling was used to identify factors associated with the use of GA.

Results

Of 760,926 CDs, 4.9% were performed under GA. This proportion decreased from 7.5% in 2003 to 2.9% in 2014 (P < 0.001). In the final multilevel model, the following patients-level factors were significantly associated with the use of GA (Table): maternal age < 19 years, racial minority, self-pay insurance, not residing in a large metropolitan area, higher comorbidity index, non-elective admission, emergent CD, intrapartum CD, and admission during weekend. Five hospital-level factors were also significantly associated with the use of GA: non-teaching status, proportions of high-risk pregnancies < 15% or > 30%, increased proportion of minority women, annual CD volume < 500 or > 1500, and 2 or 3 neonatal level-of-care.

Discussion

Adjusting for a high number of confounders in a large dataset, we did not confirm a higher GA use in teaching institutions compared with non-academic centers. Increased staffing during weekends, improving process of care in non-teaching hospitals (e.g.better equipment and skills to perform NA), or referring high-risk women to specialized centers may be actionable interventions to improve maternal safety (3). Mechanisms accounting for the use of GA in minority women, low- and-high CD volume hospitals, and level 2 or 3 hospitals remain to be determined.

1.Anesth Analg 2017;124:1914-7.

2.Int J Obstet Anesth 2011;20: 10-6.

3.Acad Med 2012;87:701-8.



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