Newly Published
Perioperative Medicine  |   December 2018
Anesthesiologist Specialization and Use of General Anesthesia for Cesarean Delivery
Author Notes
  • From the Departments of Anesthesiology and Critical Care (B.T.C., M.B.L-F., R.C.M., O.C.O., M.D.N) and Obstetrics and Gynecology (S.K.S.), Perelman School of Medicine of the University of Pennsylvania; the Leonard Davis Institute of Health Economics, and the Center for Perioperative Outcomes Research and Transformation, University of Pennsylvania (B.T.C., M.B.L-F., M.D.N.), Philadelphia, Pennsylvania.
  • Submitted for publication March 26, 2018. Accepted for publication October 31, 2018.
    Submitted for publication March 26, 2018. Accepted for publication October 31, 2018.×
  • Correspondence: Address correspondence to Dr. Cobb: 1303A-6 Blockley Hall, 423 Guardian Drive, Philadelphia, Pennsylvania, 19104. bentcobb@gmail.com. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Obstetric Anesthesia
Perioperative Medicine   |   December 2018
Anesthesiologist Specialization and Use of General Anesthesia for Cesarean Delivery
Anesthesiology Newly Published on December 28, 2018. doi:10.1097/ALN.0000000000002534
Anesthesiology Newly Published on December 28, 2018. doi:10.1097/ALN.0000000000002534
Abstract

Editor’s Perspective:

What We Already Know about This Topic:

  • Obstetric specialty societies recommend neuraxial anesthesia, when possible, for cesarean delivery

  • Current data regarding the association of obstetric anesthesiologist specialization and use of general anesthesia for cesarean delivery remain lacking

What This Manuscript Tells Us That Is New:

  • Maternal and provider factors are strongly associated with use of general anesthesia for cesarean delivery

  • Patients receiving care from obstetric-specialized anesthesiologists are 29% less likely to receive general anesthesia for cesarean delivery

Background: Guidelines for obstetric anesthesia recommend neuraxial anesthesia (i.e., spinal or epidural block) for cesarean delivery in most patients. Little is known about the association of anesthesiologist specialization in obstetric anesthesia with a patient’s likelihood of receiving general anesthesia. The authors conducted a retrospective cohort study to compare utilization of general anesthesia for cesarean delivery among patients treated by generalist versus obstetric-specialized anesthesiologists.

Methods: The authors studied patients undergoing cesarean delivery for live singleton pregnancies from 2013 through 2017 at one academic medical center. Data were extracted from the electronic medical record. The authors estimated the association of anesthesiologist specialization in obstetric anesthesia with the odds of receiving general anesthesia for cesarean delivery.

Results: Of the cesarean deliveries in our sample, 2,649 of 4,052 (65.4%) were performed by obstetric-specialized anesthesiologists, and 1,403 of 4,052 (34.6%) by generalists. Use of general anesthesia differed for patients treated by specialists and generalists (7.3% vs. 12.1%; P < 0.001). After adjustment, the odds of receiving general anesthesia were lower among patients treated by obstetric-specialized anesthesiologists among all patients (adjusted odds ratio, 0.71; 95% CI, 0.55 to 0.92; P = 0.011), and in a subgroup analysis restricted to urgent or emergent cesarean deliveries (adjusted odds ratio, 0.75; 95% CI, 0.56 to 0.99; P = 0.049). There was no association between provider specialization and the odds of receiving general anesthesia in a subgroup analysis restricted to evening or weekend deliveries (adjusted odds ratio, 0.76; 95% CI, 0.56 to 1.03; P = 0.085).

Conclusions: Treatment by an obstetric anesthesiologist was associated with lower odds of receiving general anesthesia for cesarean delivery; however, this finding did not persist in a subgroup analysis restricted to evening and weekend deliveries.