Newly Published
Perioperative Medicine  |   February 2019
Adverse Events and Factors Associated with Potentially Avoidable Use of General Anesthesia in Cesarean Deliveries
Author Notes
  • From the Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York (J.G., R.L., G.L.); French Institute of Health and Medical Research (INSERM), Mixed Research Unit (UMR) 1137, Infection Antimicrobials Modelling Evolution (IAME), Paris, France (J.G.); and Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York (G.L.).
  • Submitted for publication February 20, 2018. Accepted for publication December 21, 2018.
    Submitted for publication February 20, 2018. Accepted for publication December 21, 2018.×
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    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Correspondence: Address correspondence to Dr. Guglielminotti: Department of Anesthesiology, Columbia University College of Physicians and Surgeons, 622 West 168th Street, PH5-505, New York, New York 10032. jg3481@cumc.columbia.edu. 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   |   February 2019
Adverse Events and Factors Associated with Potentially Avoidable Use of General Anesthesia in Cesarean Deliveries
Anesthesiology Newly Published on February 13, 2019. doi:10.1097/ALN.0000000000002629
Anesthesiology Newly Published on February 13, 2019. doi:10.1097/ALN.0000000000002629
Abstract

Editor’s Perspective:

What We Already Know about This Topic:

  • Neuraxial anesthesia is recommended in lieu of general anesthesia for cesarean deliveries

  • The association of general anesthesia without a clinical indication with adverse events in cesarean deliveries remains poorly understood

What This Manuscript Tells Us That Is New:

  • In New York State, 5.7% of cesarean sections without a clinical indication for general anesthesia are performed with general anesthesia

  • The use of potentially avoidable general anesthesia in these patients is associated with an increased risk of anesthesia-related complications, surgical site infection, and venous thromboembolism, but not death or cardiac arrest

Background: Compared with neuraxial anesthesia, general anesthesia for cesarean delivery is associated with increased risk of maternal adverse events. Reducing avoidable general anesthetics for cesarean delivery may improve safety of obstetric anesthesia care. This study examined adverse events, trends, and factors associated with potentially avoidable general anesthetics for cesarean delivery.

Methods: This retrospective study analyzed cesarean delivery cases without a recorded indication for general anesthesia or contraindication to neuraxial anesthesia in New York State hospitals, 2003 to 2014. Adverse events included anesthesia complications (systemic, neuraxial-related, and drug-related), surgical site infection, venous thromboembolism, and the composite of death or cardiac arrest. Anesthesia complications were defined as severe if associated with death, organ failure, or prolonged hospital stay.

Results: During the study period, 466,014 cesarean deliveries without a recorded indication for general anesthesia or contraindication to neuraxial anesthesia were analyzed; 26,431 were completed with general anesthesia (5.7%). The proportion of avoidable general anesthetics decreased from 5.6% in 2003 to 2004 to 4.8% in 2013 to 2014 (14% reduction; P < 0.001). Avoidable general anesthetics were associated with significantly increased risk of anesthesia complications (adjusted odds ratio, 1.6; 95% CI, 1.4 to 1.9), severe complications (adjusted odds ratio, 2.9; 95% CI, 1.6 to 5.2), surgical site infection (adjusted odds ratio, 1.7; 95% CI, 1.5 to 2.1), and venous thromboembolism (adjusted odds ratio, 1.9; 95% CI, 1.3 to 3.0), but not of death or cardiac arrest. Labor neuraxial analgesia rate was one of the most actionable hospital-level factors associated with avoidable general anesthetics. Relative to hospitals with a rate greater than or equal to 75%, the adjusted odds ratio of avoidable general anesthetics increased to 1.3 (95% CI, 1.2 to 1.4), 1.6 (95% CI, 1.5 to 1.7), and 3.2 (95% CI, 3.0 to 3.5) as the rate decreased to 50 to 74.9%, 25 to 49.9%, and less than 25%, respectively.

Conclusions: Compared with neuraxial anesthesia, avoidable general anesthetics are associated with increased risk of adverse maternal outcomes.