Gonzalez Fiol A, Meng M-L, Danhakl V, Kim M, Miller R, Smiley R
Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA.
Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, NY, USA.
Int J Obstet Anesth. 2018 May;34:50-55. doi: 10.1016/j.ijoa.2017.12.010. Epub 2018 Jan 6.
Knowledge of hospital-specific average cesarean delivery operative times, and factors influencing length of surgery, can serve as a guide for anesthesiologists when choosing the optimal anesthetic technique. The aim of this study was to determine operative times and the factors influencing those times for cesarean delivery.
We conducted a retrospective review of all 1348 cesarean deliveries performed at an academic hospital in 2011. The primary outcome was mean operative time for first, second, third and fourth or more cesarean deliveries. The secondary goal was to identify factors influencing operative time. Variables included age, body mass index, previous surgery, gestational age, urgency of cesarean delivery, anesthesia type, surgeon's seniority, layers closed, and performance of tubal ligation.
Mean (standard deviation) operative times for first (n=857), second (n=353), third (n=108) and fourth or more (n=30) cesarean deliveries were 56 (19), 60 (19), 69 (28) and 82 (31) minutes, respectively (P <0.0001, all groups different). Emergency status of the case and later gestational age were associated with shorter operative times. Higher body mass index, a less senior surgeon, the number of layers closed, and tubal ligation, increased operative times. These factors accounted for 18% of the variability.
Third and fourth cesarean delivery or the presence of other factors that could increase operative time may warrant catheter-based anesthetic techniques or the addition of adjunctive medications to prolong spinal anesthetic block. Institutional and individual surgeon factors may play an even more important role in determining surgical time.
了解特定医院剖宫产手术的平均手术时间以及影响手术时长的因素，可为麻醉医生选择最佳麻醉技术提供指导。本研究的目的是确定剖宫产手术时间及影响这些时间的因素。
我们对2011年在一家学术医院进行的1348例剖宫产手术进行了回顾性研究。主要结局是首次、第二次、第三次及第四次或更多次剖宫产的平均手术时间。次要目标是确定影响手术时间的因素。变量包括年龄、体重指数、既往手术史、孕周、剖宫产的紧急程度、麻醉类型、外科医生资历、缝合层数以及输卵管结扎情况。
首次剖宫产（n = 857）、第二次剖宫产（n = 353）、第三次剖宫产（n = 108）以及第四次或更多次剖宫产（n = 30）的平均（标准差）手术时间分别为56（19）分钟、60（19）分钟、69（28）分钟和82（31）分钟（P < 0.0001，所有组均有差异）。病例的紧急状态和孕周较大与较短的手术时间相关。较高的体重指数、资历较浅的外科医生、缝合层数以及输卵管结扎会增加手术时间。这些因素占变异性的18%。
第三次及第四次剖宫产或存在其他可能增加手术时间的因素，可能需要采用基于导管的麻醉技术或添加辅助药物以延长脊髓麻醉阻滞时间。机构和外科医生个体因素在决定手术时间方面可能发挥更重要的作用。
