Cesarean Delivery in Queensland, Australia-A Retrospective Study of Factors Associated With Primary and Secondary General Anesthesia.

BACKGROUND

Queensland maternity services are provided by institutions of varying sizes, that are classified according to the Clinical Services Capability Framework. Obesity is more common in more remote areas. We aimed to identify factors associated primary and secondary general anesthesia in Queensland, Australia.

METHODS

Data were obtained from the Anaesthesia Benchmarking System and Mater Health Services between January 2019 and July 2022. The Accessibility/Remoteness Index of Australia Plus classification was used to describe remoteness and the institutional Clinical Services Capability Framework level documented. Associations of individual characteristics, cesarean characteristics and remoteness category with the outcomes of primary and secondary GA, were explored using chi-square tests and modelled using binary logistic regression.

RESULTS

Of 35,227 cases, 22,780 (64.7%) resided in major cities with a median (IQR) body mass index of 29.0 kg m (25.0-34.5). Primary general anesthesia occurred in 1562 (4.4%) and secondary general anesthesia in 1336 (3.8%). Primary general anesthesia occurred more commonly in category 1 cesarean (adjusted odds ratio, aOR 31.49, 95% CI 27.00-36.84) and those with a mental health condition (aOR 1.82, 95% CI 1.57-2.10), both p < 0.001. Primary GA occurred less commonly in nulliparous women (aOR 0.56, 95% CI 0.49-0.63, p < 0.001). Secondary general anesthesia was more likely in those with category 1 surgical urgency (aOR 12.62, 95% CI 10.58-15.07), post-partum hemorrhage (aOR 2.74, 95% CI 2.32-3.23), lowest BMI category (aOR 2.13, 95% CI 1.44-3.07), highest BMI category (aOR 1.71, 95% CI 1.41-2.07) and presence of a mental health condition (aOR 1.57, 95% CI 1.35-1.82), all variables p < 0.001. Clinical Services Capability Framework level 4 and 5 institutions cared for significantly more women with body mass index ≥ 40 kg m however more women with body mass index ≥ 40 kg m resided in remote/very remote locations.

CONCLUSION

Anesthetists may use these results to anticipate secondary general anesthesia or modify primary techniques. Institutions located in remote areas and with fewer resources cared for more women with obesity, with implications for women and healthcare services.