Clifton B, Park Y L, Ashraf R, Sanchez A G, McCarthy R J, Neuman M D, Lim G
Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; University of Minnesota Medical School, University of Minnesota, Minneapolis, MN, United States.
Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
Int J Obstet Anesth. 2025 Aug 29;64:104760. doi: 10.1016/j.ijoa.2025.104760.
Patient priorities for anesthesia during a cesarean delivery are not well defined. Previous studies have explored patient preferences for cesarean delivery anesthesia but have not evaluated patient-centered endpoints unrelated to the physical experience which are known to be important to patients' birth experiences, such as being treated with respect, communication, and emotional support. The purpose of this study was to compare patients' and providers' priorities for cesarean delivery anesthesia care.
This prospective cross-sectional quantitative survey study included patients with recent cesarean deliveries and clinical providers who provide clinical care for cesarean deliveries. Eleven patient-centered factor related to cesarean delivery anesthesia experience were identified based on previously reported findings and results of semi-structured interviews. Participants then completed a forced ranking survey for these 11 factor, ranked in order from most important to least important aspect of cesarean anesthesia care. They also ranked most desired to least desired anesthesia side effects (e.g. pruritus, nausea, pain). Participants also rated their perceived importance of the factor ranked highest and lowest on a 0-10 numeric rating scale (0 = not important at all and 10 = most important imaginable). Rankings from patient and provider groups were compared using Plackett-Luce method using tree-based recursive partitioning.
One hundred forty-four respondents (127 patients, 17 providers) were included in the analysis. "Physical safety of the baby" was ranked highest among patients and was higher than the rank assigned by providers (P < 0.001). Although mothers with vs. without self-reported birth trauma each highly prioritized safety of baby, the relative priority placed on this factor was higher among mothers with self-reported birth trauma. For anesthesia-related side effects, patients and providers agreed that memory loss, spinal headaches, and pain or discomfort during surgery, represented high-priority concerns to avoid; drowsiness, shivering, and pruritus were considered lower-priority. There were ranking differences between in-person and digital recruited patients.
Patients and providers have discordant views on priorities during cesarean delivery, and similar views on priorities for anesthesia-related side effects. A self-reported history of birth trauma, but not pain during cesarean delivery, is associated with high prioritization of physical safety of mother and baby over other cesarean experience priorities. Future clinical care improvements and research are needed to help patients and providers balance the outcomes most important to patients during and after cesarean delivery.
剖宫产麻醉时患者的优先事项尚未明确界定。以往研究探讨了患者对剖宫产麻醉的偏好，但未评估与身体体验无关的以患者为中心的终点指标，而这些指标已知对患者的分娩体验很重要，例如受到尊重、沟通和情感支持。本研究的目的是比较患者和医护人员对剖宫产麻醉护理的优先事项。
这项前瞻性横断面定量调查研究纳入了近期有剖宫产经历的患者以及为剖宫产提供临床护理的医护人员。基于先前报告的结果和半结构化访谈的结果，确定了11个与剖宫产麻醉体验相关的以患者为中心的因素。参与者随后对这11个因素完成了一项强制排序调查，按照剖宫产麻醉护理最重要到最不重要的方面进行排序。他们还对最期望到最不期望的麻醉副作用（如瘙痒、恶心、疼痛）进行了排序。参与者还在0至10的数字评分量表上对他们认为最重要和最不重要的因素的重要性进行评分（0 = 完全不重要，10 = 可以想象到的最重要）。使用基于树的递归划分的Plackett-Luce方法比较患者组和医护人员组的排序。
144名受访者（127名患者，17名医护人员）纳入分析。“婴儿的身体安全”在患者中排名最高，且高于医护人员给出的排名（P < 0.001）。尽管有自我报告分娩创伤的母亲与没有自我报告分娩创伤的母亲都高度重视婴儿的安全，但有自我报告分娩创伤的母亲对该因素的相对重视程度更高。对于与麻醉相关的副作用，患者和医护人员一致认为记忆丧失、脊髓性头痛以及手术期间疼痛或不适是需要避免的高度优先关注问题；嗜睡、寒战和瘙痒被认为是较低优先级的问题。亲自招募的患者和通过数字方式招募的患者之间存在排名差异。
患者和医护人员在剖宫产期间的优先事项上存在不一致的看法，而在与麻醉相关副作用的优先事项上看法相似。自我报告的分娩创伤史，而非剖宫产期间的疼痛，与将母婴身体安全置于高于其他剖宫产体验优先事项的高度优先地位相关。未来需要改进临床护理并开展研究，以帮助患者和医护人员在剖宫产期间及之后平衡对患者最重要的结果。
