Cesarean Delivery in Queensland, Australia-A Retrospective Study of Factors Associated With Primary and Secondary General Anesthesia.
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| Titel: | Cesarean Delivery in Queensland, Australia-A Retrospective Study of Factors Associated With Primary and Secondary General Anesthesia. |
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| Autoren: | Eley VA; 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., Pelecanos A; Statistics Unit, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia., Lawrence S; 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.; Mater Health Services, South Brisbane, Queensland, Australia., Bertrand S; Medical School, Faculty of Medicine, The University of Queensland, St Lucia, Queensland, Australia.; Mater Health Services, South Brisbane, Queensland, Australia., Kothari A; Medical School, Faculty of Medicine, The University of Queensland, St Lucia, Queensland, Australia.; Redcliffe Hospital, Redcliffe, Queensland, Australia., Whitcombe D; Medical School, Faculty of Medicine, The University of Queensland, St Lucia, Queensland, Australia.; Toowoomba Hospital, Toowoomba, Queensland, Australia., Godsall MG; Sunshine Coast University Hospital, Birtinya, Queensland, Australia.; University of Sunshine Coast, Sippy Downs, Queensland, Australia. |
| Quelle: | Acta anaesthesiologica Scandinavica [Acta Anaesthesiol Scand] 2025 Oct; Vol. 69 (9), pp. e70093. |
| Publikationsart: | Journal Article |
| Sprache: | English |
| Info zur Zeitschrift: | Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 0370270 Publication Model: Print Cited Medium: Internet ISSN: 1399-6576 (Electronic) Linking ISSN: 00015172 NLM ISO Abbreviation: Acta Anaesthesiol Scand Subsets: MEDLINE |
| Imprint Name(s): | Publication: Oxford, UK : Wiley-Blackwell Original Publication: Aarhus, Denmark : Universitetsforlaget, 1957- |
| MeSH-Schlagworte: | Cesarean Section*/statistics & numerical data , Anesthesia, General*/statistics & numerical data , Anesthesia, Obstetrical*/statistics & numerical data , Anesthesia, Obstetrical*/methods, Humans ; Female ; Pregnancy ; Retrospective Studies ; Adult ; Queensland/epidemiology ; Body Mass Index |
| Abstract: | 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 -2 (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 -2 however more women with body mass index ≥ 40 kg m -2 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. (© 2025 The Author(s). Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.) |
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| Grant Information: | Metro North Hospital and Health Service |
| Contributed Indexing: | Keywords: Queensland; body mass index; cesarean; general anesthesia; postpartum hemorrhage |
| Entry Date(s): | Date Created: 20250915 Date Completed: 20250916 Latest Revision: 20250917 |
| Update Code: | 20250917 |
| PubMed Central ID: | PMC12435121 |
| DOI: | 10.1111/aas.70093 |
| PMID: | 40952129 |
| Datenbank: | MEDLINE |
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Nájsť tento článok vo Web of Science | Abstract: | 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.<br />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.<br />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 <sup>-2</sup> (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 <sup>-2</sup> however more women with body mass index ≥ 40 kg m <sup>-2</sup> resided in remote/very remote locations.<br />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.<br /> (© 2025 The Author(s). Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.) |
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| ISSN: | 1399-6576 |
| DOI: | 10.1111/aas.70093 |