The effect of COVID‐19 on general anaesthesia rates for caesarean section. A cross‐sectional analysis of six hospitals in the north‐west of England

Abstract

Summary At the onset of the global pandemic of COVID‐19 (SARS‐CoV‐2), guidelines recommended using regional anaesthesia for caesarean section in preference to general anaesthesia. National figures from the UK suggest that 8.75% of over 170,000 caesarean sections are performed under general anaesthetic. We explored whether general anaesthesia rates for caesarean section changed during the peak of the pandemic across six maternity units in the north‐west of England. We analysed anaesthetic information for 2480 caesarean sections across six maternity units from 1 April to 1 July 2020 (during the pandemic) and compared this information with data from 2555 caesarean sections performed at the same hospitals over a similar period in 2019. Primary outcome was change in general anaesthesia rate for caesarean section. Secondary outcomes included overall caesarean section rates, obstetric indications for caesarean section and regional to general anaesthesia conversion rates. A significant reduction (7.7 to 3.7%, p < 0.0001) in general anaesthetic rates, risk ratio (95%CI) 0.50 (0.39–0.93), was noted across hospitals during the pandemic. Regional to general anaesthesia conversion rates reduced (1.7 to 0.8%, p = 0.012), risk ratio (95%CI) 0.50 (0.29–0.86). Obstetric indications for caesarean sections did not change (p = 0.17) while the overall caesarean section rate increased (28.3 to 29.7%), risk ratio (95%CI) 1.02 (1.00–1.04), p = 0.052. Our analysis shows that general anaesthesia rates for caesarean section declined during the peak of the pandemic. Anaesthetic decision‐making, recommendations from anaesthetic guidelines and presence of an on‐site anaesthetic consultant in the delivery suite seem to be the key factors that influenced this decline.

Estimation of the Number of General Anesthesia Cases Based on a Series of Nationwide Surveys on Twitter during COVID-19 Pandemic in Japan: A Statistical Analysis

“…A nationwide questionnaire survey in Turkey demonstrated that 62.1% of the responders stopped elective surgeries after the first case was reported in Turkey (11 March 2020) [ 13 ]. A cross-sectional analysis in northwest England reported that the general anesthesia rates for cesarean section were significantly reduced from 7.7% to 3.7% due to the COVID-19 pandemic [ 14 ]. The largest, latest nationwide survey from the COVIDSurg group showed that 72.3% of surgeries were canceled or postponed during the 12-week peak of disruption caused by the COVID-19 pandemic [ 15 ].…”

Pandemics and maternal health: the indirect effects of COVID‐19

“…Bhatia et al. analysed anaesthetic information for 2480 caesarean sections across six maternity units from April to July 2020 (during the first wave of the pandemic in the UK) [21]. They compared it with data from 2555 caesarean sections performed at the same hospitals over a similar period in 2019.…”

Incidence and Associated Factors for Neuraxial Anaesthesia-Related Hypotension in COVID-19 Parturients Undergoing Caesarean Delivery: A Multicenter Case-Control Study

“…Although the clinical characteristics of COVID-19 parturients is similar with non-pregnant COVID-19 patients (Allotey, Stallings et al, 2020), COVID-19 results in additional challenges for perioperative management in parturients (Zheng, Hebert et al, 2020) and the outcomes of maternal and fetal appeared barely satisfactory (Yu, Li et al, 2020). Based on clinical practices and expert opinions, neuraxial anaesthesia in preference to general anaesthesia for caesarean delivery in COVID-19 parturients (Bhatia, Columb et al, 2020). However, more attention should be focused on neuraxial anaesthesia-related hypotension in COVID-19 parturients.…”