Eley Victoria A, Pelecanos Anita, Lawrence Sue, Bertrand Suzanne, Kothari Alka, Whitcombe Doogie, Godsall M Guy
Department of Anaesthesia and Perioperative Medicine, The Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
Medical School, Faculty of Medicine, The University of Queensland, St Lucia, Queensland, Australia.
Acta Anaesthesiol Scand. 2025 Oct;69(9):e70093. doi: 10.1111/aas.70093.
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.
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.
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.
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.
昆士兰的产科服务由规模各异的机构提供，这些机构根据临床服务能力框架进行分类。肥胖在偏远地区更为常见。我们旨在确定澳大利亚昆士兰地区与初次和二次全身麻醉相关的因素。
数据取自2019年1月至2022年7月的麻醉基准系统和孕产妇健康服务。使用澳大利亚加可及性/偏远指数分类来描述偏远程度，并记录机构临床服务能力框架水平。通过卡方检验探索个体特征、剖宫产特征和偏远类别与初次和二次全身麻醉结果之间的关联，并使用二元逻辑回归进行建模。
在35227例病例中，22780例（64.7%）居住在主要城市，体重指数中位数（IQR）为29.0 kg/m²（25.0 - 34.5）。初次全身麻醉发生在1562例（4.4%），二次全身麻醉发生在1336例（3.8%）。初次全身麻醉在1类剖宫产中更常见（调整比值比，aOR 31.49，95%CI 27.00 - 36.84）以及患有精神健康疾病的患者中更常见（aOR 1.82，95%CI 1.57 - 2.10），两者p < 0.001。初次全身麻醉在未生育女性中较少见（aOR 0.56，95%CI 0.49 - 0.63，p < 0.001）。二次全身麻醉在1类手术紧急情况患者中更有可能发生（aOR 12.62，95%CI 10.58 - 15.07）、产后出血患者中（aOR 2.74，95%CI 2.32 - 3.23）、最低体重指数类别患者中（aOR 2.13，95%CI 1.44 - 3.07）、最高体重指数类别患者中（aOR 1.71，95%CI 1.41 - 2.07）以及患有精神健康疾病的患者中（aOR 1.57，95%CI 1.35 - 1.82），所有变量p < 0.001。临床服务能力框架4级和5级机构照顾体重指数≥40 kg/m²的女性明显更多，但体重指数≥40 kg/m²的女性更多居住在偏远/非常偏远地区。
麻醉医生可利用这些结果预测二次全身麻醉或调整初次技术。位于偏远地区且资源较少的机构照顾肥胖女性更多，这对女性和医疗服务有影响。
