Cesarean anesthesia associated with surgical site infections and thromboembolism
44% of general anesthesia cases for cesarean delivery are potentially avoidable and in comparison to neuraxial anesthesia (avoidable general anesthetics) is associated with an increased risk of adverse maternal outcomes including venous thromboembolism and surgical site infection, suggests a recent study.
The study published in the ASA journal Anesthesiology further found that low hospital-level use of neuraxial techniques during labor was one of the strongest predictors of potentially avoidable use of general anesthesia for cesarean delivery.
It is already known that compared with neuraxial anesthesia, general anesthesia for cesarean delivery is associated with increased risk of maternal adverse events. A reduction in avoidable general anesthetics for cesarean delivery may improve the safety of obstetric anesthesia care. Jean Guglielminotti, From the Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York, and colleagues examined adverse events, trends, and factors associated with potentially avoidable general anesthetics for cesarean delivery.
This retrospective study analyzed 466,014 cesarean delivery cases without a recorded indication for general anesthesia or contraindication to neuraxial anesthesia; 26,431 were completed with general anesthesia (5.7%). 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.
- The proportion of avoidable general anesthetics decreased from 5.6% in 2003 to 2004 to 4.8% in 2013 to 2014 (14% reduction).
- Avoidable general anesthetics were associated with significantly increased risk of anesthesia complications, severe complications, surgical site infection, and venous thromboembolism, 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, 1.6, and 3.2 as the rate decreased to 50 to 74.9%, 25 to 49.9%, and less than 25%, respectively.
Based on the study, the authors concluded that compared with neuraxial anesthesia, avoidable general anesthetics are associated with increased risk of adverse maternal outcomes.
For detailed study follow the link: doi:10.1097/ALN.0000000000002629