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Anesthetic practice for C aesarean section and factors influencing anesthesiologists' choice of anesthesia: a population‐based study
Author(s) -
LAI H.Y.,
TSAI P.S.,
FAN Y.C.,
HUANG C.J.
Publication year - 2014
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.12350
Subject(s) - medicine , odds ratio , logistic regression , caesarean section , anesthesia , confidence interval , anesthetic , preeclampsia , population , pregnancy , obstetrics , environmental health , genetics , biology
Background We examined the change in anesthetic practice for C aesarean section ( CS ) during the past decade and determined factors influencing anethesiologists' decisions. Methods The cases were identified from data retrieved from L ongitudinal H ealth I nsurance D atabase released by the T aiwan N ational H ealth R esearch I nstitute in 2008. Trend analysis was performed using logistic regression models. The decision tree analysis was performed using the chi‐squared automatic interaction detector method and multivariable logistic regression analysis was performed to identify predictors of general anesthesia. Results A total of 25,606 women undergoing CS were studied. Logistic regression analyses revealed an upward trend of spinal anesthesia from 2000 to 2008 [57.8–67.5%, adjusted odds ratio ( OR ) = 1.06, 95% confidence interval ( CI ) = 1.05–1.07, P < 0.001] and a decreasing trend across time for both general and epidural anesthesia (5.5–3.9% and 36.7–28.6%; both OR < 1, both P < 0.001). Patterns of change in anesthetic practice across time for emergency and non‐emergency CS were similar (all P < 0.05). Our data further demonstrated that early or threatened labor, a history of preeclampsia, antepartum hemorrhage, emergency CS , and previous CS were important predictors that influenced the anesthesiologists' choice of general anesthesia versus neuraxial anesthesia for women undergoing CS . Conclusions Spinal anesthesia was the most common mode of anesthesia for CS deliveries in T aiwan during the past decade. Early or threatened labor, antepartum hemorrhage, emergency CS , previous CS , and preeclampsia are significant determinants of general anesthesia in CS deliveries.