Evaluation of changes in anesthetic methods for cesarean delivery: an analysis for 5 years using the big data of the Korean Health Insurance Review and Assessment Service

Park, Ji In; Park, Sang Hi; Kang, Min Seok; Kang, Gilwon

doi:10.17085/apm.20021

Cited by 5 publications

(7 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As such, we were concerned about the possibility of selection bias. Literature data on the relative proportions of anesthetic methods used for cesarean deliveries are available only from 2013 to 2018 [ 6 ]. Analysis thereof showed that the rate of spinal anesthesia increased from 40.0% in 2013 to 53.7% in 2018, while the opposite trend was observed in general anesthesia, which decreased from 37.1% in 2013 to 22.2% in 2018.…”

Section: Discussionmentioning

confidence: 99%

“…The exclusion criteria were malignancies (C00-97), diseases of the blood and blood-forming organs, immune-system disorders (D50-89), obstetric trauma causing rupture of the uterus (O71), and antepartum hemorrhage (O46). The anesthetic methods were categorized into general anesthesia (L1211, L1221), spinal anesthesia (L1213, L1223), and epidural anesthesia (L1214, L1224), based on a previous study reporting trends in anesthetic methods in Korea [ 6 ]. Cases in which the anesthetic method could not be verified were excluded from the analysis.…”

Section: Methodsmentioning

confidence: 99%

“…Neuraxial anesthesia is generally preferred over general anesthesia for cesarean section [ 6 , 7 ]. The main reason is the difficult airway management associated with general anesthesia, but other factors also influence the decision, including intraoperative awareness, postoperative bleeding, neonatal safety, postoperative pain management, and maternal bonding with the newborn following delivery [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…According to previous reports, general anesthesia is used in about 6% of planned cesarean deliveries in the United States [ 8 ]. A study of the anesthetic methods used for cesarean delivery in Korea between 2013 and 2018 reported that general and regional anesthesia were used in 27.4% and 72.6% of cesarean deliveries, respectively [ 6 ]. While the use of general anesthesia has declined significantly, it is still used much more frequently in Korea compared to other countries [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Association between anesthetic method and postpartum hemorrhage in Korea based on National Health Insurance Service data

et al. 2022

View full text Add to dashboard Cite

Background: Postpartum hemorrhage (PPH) is a major cause of maternal mortality. An increasing incidence of PPH has been reported in many countries. The risk factors for PPH differ among studies and it can occur in patients with no known risk factors. In this large-scale study, we investigated whether the anesthetic method used was associated with PPH after cesarean section.Methods: We extracted data on cesarean sections performed between January 2008 and June 2013 from the National Health Insurance Service database. The anesthetic methods were categorized into general, spinal and epidural anesthesia. To compare the likelihood of PPH among deliveries using different anesthetic methods, crude and adjusted odds ratios (ORs) and 95% confidence intervals were calculated using logistic regression analysis.Results: Data from 330,324 cesarean sections were analyzed, and 21,636 cases of PPH were identified. Univariate analysis showed that general and epidural anesthesia increased the risk of PPH compared to spinal anesthesia. The OR for PPH was highest for morbidly adherent placenta, followed by placenta previa, placental abruption, and hypertension. When other clinical covariates were controlled for, general and epidural anesthesia still remained significant risk factors for PPH compared to spinal anesthesia.Conclusions: This study showed that general and epidural anesthesia elevated the risk of PPH compared to spinal anesthesia during cesarean section. Since we could not consider the potential bias of group differences in indications, more in-depth clinical trials are needed to validate our findings. Obstetric factors such as placental abnormalities had high odds ratios and thus are more important than the choice of anesthetic method, which should be based on the patient’s clinical condition and institutional resources.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Association between anesthetic method and postpartum hemorrhage in Korea based on National Health Insurance Service data

et al. 2022

View full text Add to dashboard Cite

show abstract

“…In Korea, approximately 28.8% of cesarean sections have been performed under general anesthesia over the past five years [35], but the rate of general anesthesia limited to the obese parturient group has not yet been reported. The rate of general anesthesia in Korea is significantly higher than that in Western countries [36].…”

Section: General Anesthesiamentioning

confidence: 99%

Anesthetic management of obese and morbidly obese parturients

Kim

2021

Anesth Pain Med

Self Cite

View full text Add to dashboard Cite

The prevalence of obese parturients is increasing worldwide. This review describes safe analgesic techniques for labor and anesthetic management during cesarean sections in obese parturients. The epidural analgesic technique is the best way to provide good pain relief during the labor phase and can be easily converted to a surgical anesthetic condition. However, the insertion of the epidural catheter in obese parturients is technically more difficult compared to that in non-obese parturients. The distance from the skin to the epidural space increases in proportion to the body mass index (BMI): 4.4 cm in mothers of normal weight and 7.5 cm in mothers with BMI 50 and above. Neuraxial blocks are the ideal anesthetic methods and gold standard techniques for cesarean section in pregnant women with obesity. Single-shot spinal anesthesia is the most common type of anesthesia used for cesarean sections. The advantage of single-shot spinal anesthesia is a dense-sufficient block of rapid onset. A combined spinal-epidural (CSE) anesthetic technique is also recommended as an attractive alternative method. In obese parturients, the operation time can be longer than expected, and therefore, the CSE technique provides the advantage of rapid onset and intense block for prolonged operation with postoperative pain control. The risk of postoperative complications is very high in obese parturients. Therefore, detailed communication of the parturient's medical condition and the details of surgery and anesthesia between the anesthesiologist and obstetrician is important prior to cesarean section in obese pregnant women.

show abstract

Effect of anesthesia type on outcome measures in cesarean section in the presence of fetal macrosomia

Temür

Kilicarslan

2022

Rev. Assoc. Med. Bras.

View full text Add to dashboard Cite

OBJECTIVE:The aim of this study was to compare the effects of general and spinal anesthesia on maternal and neonatal outcomes during cesarean section in pregnancies with macrosomia. METHODS: This retrospective cohort study included 1043 patients who delivered by cesarean section between May 2018 and December 2021 and had a baby born with a birth weight of 4000 g or greater. Maternal and neonatal outcomes were compared according to the type of anesthesia performed in the spinal anesthesia group (n=903; 86.6%) and general anesthesia group (n=140; 13.4%). The Apgar score was categorized into <7 and ≥7. RESULTS: Neonates with an Apgar score of <7 at the first minute (11.4 vs. 0.4%; p<0.001) and the fifth minute (2.9 vs. 0.3%; p=0.004) were significantly higher in the general anesthesia group. The preoperative and postoperative hematocrit difference was significantly lower in patients who received spinal anesthesia than those who received general anesthesia [2 (1.1-3.1) vs. 4.05 (2.8-5.35); p<0.001]. The number of patients transfused was higher in the general anesthesia group (9.3 vs. 2.7%; p<0.001). In the regression model, general anesthesia, birth weight, and emergency conditions were significant independent factors related to the preoperative and postoperative hematocrit decrease (p<0.001, p=0.005, and p=0.034, respectively). CONCLUSIONS: Apgar scores of <7 at the first and fifth minutes are higher in macrosomic neonates who received general anesthesia than in neonates who received spinal anesthesia. Performing cesarean section under general anesthesia in mothers of macrosomic neonates results in a greater decrease in hematocrit value and a greater need for blood transfusion than under spinal anesthesia.

show abstract

Evaluation of changes in anesthetic methods for cesarean delivery: an analysis for 5 years using the big data of the Korean Health Insurance Review and Assessment Service

Cited by 5 publications

References 20 publications

Association between anesthetic method and postpartum hemorrhage in Korea based on National Health Insurance Service data

Association between anesthetic method and postpartum hemorrhage in Korea based on National Health Insurance Service data

Anesthetic management of obese and morbidly obese parturients

Effect of anesthesia type on outcome measures in cesarean section in the presence of fetal macrosomia

Contact Info

Product

Resources

About