From the Departments of Anesthesiology and Critical Care (B.T.C., M.B.L-F., R.C.M., O.C.O., M.D.N) Obstetrics and Gynecology (S.K.S.), Perelman School of Medicine of the University of Pennsylvania the Leonard Davis Institute of Health Economics, and the Center for Perioperative Outcomes Research and Transformation, University of Pennsylvania (B.T.C., M.B.L-F., M.D.N.), Philadelphia, Pennsylvania.
Anesthesiology. 2019 Feb;130(2):237-246. doi: 10.1097/ALN.0000000000002534.
Guidelines for obstetric anesthesia recommend neuraxial anesthesia (i.e., spinal or epidural block) for cesarean delivery in most patients. Little is known about the association of anesthesiologist specialization in obstetric anesthesia with a patient's likelihood of receiving general anesthesia. The authors conducted a retrospective cohort study to compare utilization of general anesthesia for cesarean delivery among patients treated by generalist versus obstetric-specialized anesthesiologists.
The authors studied patients undergoing cesarean delivery for live singleton pregnancies from 2013 through 2017 at one academic medical center. Data were extracted from the electronic medical record. The authors estimated the association of anesthesiologist specialization in obstetric anesthesia with the odds of receiving general anesthesia for cesarean delivery.
Of the cesarean deliveries in our sample, 2,649 of 4,052 (65.4%) were performed by obstetric-specialized anesthesiologists, and 1,403 of 4,052 (34.6%) by generalists. Use of general anesthesia differed for patients treated by specialists and generalists (7.3% vs. 12.1%; P < 0.001). After adjustment, the odds of receiving general anesthesia were lower among patients treated by obstetric-specialized anesthesiologists among all patients (adjusted odds ratio, 0.71; 95% CI, 0.55 to 0.92; P = 0.011), and in a subgroup analysis restricted to urgent or emergent cesarean deliveries (adjusted odds ratio, 0.75; 95% CI, 0.56 to 0.99; P = 0.049). There was no association between provider specialization and the odds of receiving general anesthesia in a subgroup analysis restricted to evening or weekend deliveries (adjusted odds ratio, 0.76; 95% CI, 0.56 to 1.03; P = 0.085).
Treatment by an obstetric anesthesiologist was associated with lower odds of receiving general anesthesia for cesarean delivery; however, this finding did not persist in a subgroup analysis restricted to evening and weekend deliveries.
产科麻醉指南建议大多数患者行椎管内麻醉（即脊髓或硬膜外阻滞）行剖宫产。对于麻醉医师的产科麻醉专业程度与患者接受全身麻醉的可能性之间的关联，知之甚少。作者进行了一项回顾性队列研究，比较了由普通麻醉医师与产科专业麻醉医师治疗的患者行剖宫产时全身麻醉的使用率。
作者研究了 2013 年至 2017 年期间在一家学术医疗中心行择期单胎活产剖宫产的患者。数据从电子病历中提取。作者估计了产科麻醉专业麻醉医师的专业化程度与行剖宫产时接受全身麻醉的几率之间的关联。
在我们的样本中，4052 例剖宫产中有 2649 例（65.4%）由产科专业麻醉医师完成，1403 例（34.6%）由普通麻醉医师完成。接受专家和普通医师治疗的患者之间全身麻醉使用率不同（7.3%比 12.1%；P<0.001）。校正后，在所有患者中，接受产科专业麻醉医师治疗的患者接受全身麻醉的几率较低（校正后的优势比，0.71；95%CI，0.55 至 0.92；P=0.011），在仅限于紧急或紧急剖宫产的亚组分析中，校正后的优势比（0.75；95%CI，0.56 至 0.99；P=0.049）。在仅限于傍晚或周末分娩的亚组分析中，提供者专业化与接受全身麻醉的几率之间没有关联（校正后的优势比，0.76；95%CI，0.56 至 1.03；P=0.085）。
由产科麻醉医师治疗与接受剖宫产全身麻醉的几率降低相关；然而，在仅限于傍晚和周末分娩的亚组分析中，这一发现并不成立。
