Obstetrics & Gynecology ·
Obstetric anesthesia best-practice adherence varied across 289,047 cesarean deliveries
A multicenter retrospective cohort study assessed adherence to seven guideline-supported obstetric anesthesia practices in 289,047 cesarean deliveries recorded from 2015 to 2022. Adherence ranged from 55.4% for postspinal vasopressor infusions to 97.0% for avoiding general anesthesia, with lower adherence associated with evening or overnight cases and some patient and institutional factors.
- Adherence ranged from 55.4% to 97.0% across seven practices.
- Vasopressor infusion use was the least-adhered measure.
- Evening and overnight deliveries had lower adherence.
- The observational study did not test intervention effects.
Researchers analyzed cesarean deliveries in women aged 15 to 44 years recorded in the Multicenter Perioperative Outcomes Group database from 2015 to 2022. The retrospective cohort study measured adherence to seven practices based on societal guidance: timely antibiotics, maintaining postspinal systolic blood pressure above 90 mmHg, avoiding general anesthesia, preventing perioperative hypothermia, using low-dose neuraxial morphine, administering postspinal vasopressor infusions, and using spinal needles 25-gauge or smaller.
Among 289,047 cases, adherence was highest for avoiding general anesthesia (97.0%) and maintaining postspinal systolic blood pressure (96.7%). Timely antibiotic administration was recorded in 86.2% of cases, and use of needles 25-gauge or smaller in 89.0%. Adherence was lower for low-dose neuraxial morphine (74.2%), hypothermia prevention (56.7%), and postspinal vasopressor infusions (55.4%). Lower adherence was associated with higher patient physical status, evening or overnight delivery, and hospitals without an obstetric fellowship or Center of Excellence status.
The findings identify variation in implementation and potential targets for quality improvement. This observational study reports adherence, not effects of interventions on maternal or neonatal outcomes; associations do not establish causes of lower adherence.
In practice
This cohort documents substantial variation in adherence to seven guideline-supported anesthesia practices across cesarean deliveries, with the largest gaps in postspinal vasopressor infusion use and hypothermia prevention. The results may help anesthesia teams identify processes to review locally, particularly for evening and overnight cases. They do not show that increasing adherence improves clinical outcomes or that the reported associations cause lower adherence; the study is observational and does not evaluate a quality-improvement intervention.
AI-generated clinical interpretation · Not editor-reviewed
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Anesthesiology: Frequency of Adherence to Obstetric Anesthesia Best Practices for Cesarean Delivery: A Multicenter Retrospective Cohort Analysis ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.