This retrospective study spanned a decade but included nearly half a million Cesarean Sections in New York State.
5.7% were classified as GA without a recorded indication. The study found: “The use of potentially avoidable general anesthesia in these patients is associated with an increased risk of anesthesia-related complications, surgical site infection, and venous thromboembolism, but not death or cardiac arrest”. The odds were quite significantly higher.
Risk factors for GA included age less than 19, racial or ethnic minority, Medicaid or Medicare beneficiaries, preexisting or pregnancy-associated conditions, nonelective admission, and admission during weekend, teaching hospital, neonatal level-of-care designation 1 or 3, lower use of neuraxial techniques during labor and vaginal deliveries, higher annual volume of deliveries, and higher proportion of women with a comorbidity index greater than 2.
Neuraxial anesthesia is established as the standard of care in Cesarean anesthesia absent contraindication. Higher labor epidural rates appeared to be the most actionable factor to encourage and increase the odds of neuraxial anesthesia.
Many of the other factors are either known or subject to the limitations of this retrospective study, and may be subject to coding inaccuracy, malfunctioning epidural catheters, or patient request.