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The effect of individual obstetricians on elective cesarean section surgical time
Abstract Number: F3C-136
Abstract Type: Original Research
Prediction of surgical time for cesarean delivery (CD) is important to facilitate selection of the most appropriate anesthetic technique (single-shot spinal vs. combined spinal-epidural). Although several maternal factors (e.g., BMI, prior CD) may influence surgical time, less is known about the influence of obstetricians on surgical time. Our goal was to determine the extent of the variation in surgical time for elective CD amongst obstetricians, after controlling for certain patient characteristics and obstetricians’ operative volume.
We conducted a retrospective observational study of 1090 women with singleton pregnancies undergoing elective CD under neuraxial anesthesia at a tertiary obstetric center between 2015-2017. We excluded women with abnormal placentation, ASA class ≥ 3, and if tubal ligation was also performed. Academic, private, and county obstetricians provide care at our institution. Variability of surgical times amongst individual obstetricians were assessed with linear mixed models, with the intraclass coefficient (ICC) to evaluate variation by obstetrician.
1090 elective CDs were performed between 2015 and 2017 by 62 obstetricians. The median surgical time was 54 minutes. The median times for the individual obstetricians ranged from 32 to 80 minutes (excluding two outliers of 126 and 180 minutes). The number of CDs performed by an individual obstetrician ranged from 1 to 79. Figure 1 is a caterpillar plot of unadjusted median surgical times by obstetrician. The surgical times were log-transformed in our mixed models. After adjusting for patient demographic (age, BMI) and obstetric factors (parity and gestational age) and each obstetrician’s operative volume, the ICC was 32.3% (95% CI=22.2 to 44.5%).
Our findings suggest that differences between obstetricians account for 32% of the total variability in log surgical times. Future studies are needed to examine whether the decision to use single-shot spinal anesthesia vs. combined spinal epidural is influenced by obstetrician and patient factors, and to identify factors that account for the unexplained variance in surgical time.
1. Gonzalez et al. Int J Obstet Anesth. 2018;34:50-55
2. Harris et al. Int J Obstet Anesth. 2018;34:42-49
3. Van Eijk et al. Anesth Analg. 2016;123:445–51