Obstetric Anesthesia Workforce Survey: A 30-Year Update

Traynor, Andrea J.; Aragon, Meredith; Ghosh, Debashis; Choi, Ray; Dingmann, Colleen; Tran, Zung Vu; Bucklin, Brenda A.

doi:10.1213/ane.0000000000001204

Cited by 119 publications

(61 citation statements)

References 31 publications

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“…We found that NAL use increased substantially during our multi-year program but is significantly less than the 60% rate cited for developed countries such as the USA (1). Our multi-year collaboration achieved greater success than that reported by Kopic et al (12) following their one-time intervention (from 1.2 to 2.3%), but the overall rate of approximately 10% we saw in 2015 is considerably less than the 45% rate reported by Ninidze et al (10) at the end of their multiyear intervention.…”

Section: Discussioncontrasting

confidence: 62%

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Increasing Regional Anesthesia Use in a Serbian Teaching Hospital through an International Collaboration

Baysinger

Pujic

Veličković

et al. 2017

Front. Public Health

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Many low- and middle-income countries (LMICs) report low rates of regional anesthesia (RA) use for cesarean delivery (CD), despite its association with lower maternal major morbidity and mortality. Also, the prevalence of neuraxial analgesia for labor (NAL) is often low in LMICs. We report on the results of a collaboration in clinical education over a multi-year period between Kybele Inc., an international non-profit organization, and Klinicki Centar Vojvodine (CCV), a teaching hospital in Novi Sad, Serbia, to increase RA use for CD and NAL at CCV. From late 2011 through 2015, teams from Kybele participated in annual to biannual didactic conferences and week-long bedside teaching efforts involving obstetric and anesthesia staff from CCV and surrounding hospitals. Ongoing contact occurred at least weekly between Kybele and the host to discuss progress. De-identified quality improvement data on total deliveries, numbers of elective and non-elective CDs, number of vaginal deliveries, type of anesthesia for CD, and the number of NALs were collected. RA use for CD increased to 25% in year 2015 versus 14% in base year 2011 [odds ratio (OR): 2.05; 95% confidence interval (CI): 1.73,2.42; p < 0.001]. NAL increased to 10.5% of laboring women in 2015 versus 1.2% in 2011 (OR: 9.6; 95% CI: 7.2, 12.8; p < 0.001). Greater increases for RA use during non-elective CD were observed between 2011 and 2015 (1.4 versus 7.5% of total CD; OR: 5.52; 95% CI: 2.63, 8.41; p < 0.001) relative to elective CD (12.5 versus 17.5% of total CD; OR: 1.48; 95% CI: 1.23, 1.77; p < 0.001). Overall, RA for CD increased during the 4 year collaboration but was not as great as reported in other countries with similar health-care demographics utilizing a similar program. Detailed descriptions of program interventions and barriers to change at CCV are presented.

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Section: Discussioncontrasting

confidence: 62%

“…The use of regional anesthesia (RA) for cesarean delivery (CD) has become widespread in countries in the USA and in Western Europe (1, 2). RA is associated with a lower maternal mortality risk compared to general anesthesia (GA) in both high and low- and middle-income countries (LMICs) (3–7).…”

Section: Introductionmentioning

confidence: 99%

Increasing Regional Anesthesia Use in a Serbian Teaching Hospital through an International Collaboration

Baysinger

Pujic

Veličković

et al. 2017

Front. Public Health

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“…32 Because our multilevel model adjusts for case mix, we suggest that increased use of general anesthesia during weekend may be related to understaffing or provision of care by less experienced physicians. 33,34…”

Section: Patient-level Factors Associated With General Anesthesiamentioning

confidence: 99%

Adverse Events and Factors Associated with Potentially Avoidable Use of General Anesthesia in Cesarean Deliveries

2019

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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 drugrelated), 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.

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“…It is unclear whether similar results would be seen for higher‐risk women or women undergoing cesarean delivery after a trial of labor, and further studies are needed. The very high rate of general anesthesia in each group is another demerit of this study as this practice is not consistent with obstetric anesthesia practices in Western Europe or North America, where rates of neuraxial anesthesia are substantially higher for elective CS . The use of intraoperative and postoperative exclusion criteria raises concerns about selection bias and nonutilization of intention‐to‐treat analysis; these criteria were used to avoid the inclusion of women with increased perioperative blood loss, which is not related to the mode of placental delivery.…”

Section: Discussionmentioning

confidence: 99%

How can methods of placental delivery in cesarean section affect perioperative blood loss? A randomized controlled trial of controlled cord traction versus manual removal of placenta

Altraigey

Ellaithy

Atia

et al. 2018

J of Obstet and Gynaecol

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Obstetric Anesthesia Workforce Survey: A 30-Year Update

Abstract: Since 2001, there have been significant changes in how responding hospitals provide obstetric anesthesia care and staff the labor and delivery ward. Obstetric anesthesia surveys, updated every 10 years, continue to provide information about changes in obstetric anesthesia practice.

Cited by 119 publications

References 31 publications

Increasing Regional Anesthesia Use in a Serbian Teaching Hospital through an International Collaboration

Increasing Regional Anesthesia Use in a Serbian Teaching Hospital through an International Collaboration

Adverse Events and Factors Associated with Potentially Avoidable Use of General Anesthesia in Cesarean Deliveries

How can methods of placental delivery in cesarean section affect perioperative blood loss? A randomized controlled trial of controlled cord traction versus manual removal of placenta

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