Operating room‐to‐incision interval and neonatal outcome in emergency caesarean section: a retrospective 5‐year cohort study1. (6th April 2018)

• Record Type: Journal Article
• Authors: Palmer, E.; Ciechanowicz, S.; Reeve, A.; Harris, S.; Wong, D. J. N.; Sultan, P.
• Is Part Of: Anaesthesia. Volume 73:Number 7(2018)
• Page Start: 825
• Page End: 831
• Publication Date: 2018-04-06
• Subjects: anaesthesia: general -- anaesthesia: obstetrical -- Apgar score -- caesarean section -- neonatal outcome -- urgency category; Anesthesia -- Periodicals; 617.96
• DOI: 10.1111/anae.14296
• Languages: English
• ISSNs: 0003-2409

Abstract

Summary: We conducted a 5‐year retrospective cohort study on women undergoing caesarean section to investigate factors influencing the operating room‐to‐incision interval. Time‐to‐event analysis was performed for category‐1 caesarean section using a Cox proportional hazards regression model. Covariates included: anaesthetic technique; body mass index; age; parity; time of delivery; and gestational age. Binary logistic regression was performed for 5‐min Apgar score ≥ 7. There were 677 women who underwent category‐1 caesarean section and who met the entry criteria. Unadjusted median (IQR [range]) operating room‐to‐incision intervals were: epidural top‐up 11 (7–17 [0–87]) min; general anaesthesia 6 (4–11 [0–69]) min; spinal 13 (10–20 [0–83]) min; and combined spinal‐epidural 24 (13–35 [0–75]) min. Cox regression showed general anaesthesia to be the most rapid method with a hazard ratio (95%CI) of 1.97 (1.60–2.44; p < 0.0001), followed by epidural top‐up (reference group), spinal anaesthesia 0.79 (0.65–0.96; p = 0.02) and combined spinal‐epidural 0.48 (0.35–0.67; p < 0.0001). Underweight and overweight body mass indexes were associated with longer operating room‐to‐incision intervals. General anaesthesia was associated with fewer 5‐min Apgar scores ≥ 7 with an odds ratio (95%CI) of 0.28 (0.11–0.68; p < 0.01). There was no difference in neonatal outcomes between the first and fifth quintiles for operating room‐to‐incision intervals. General anaesthesia is associated with the most rapid operating room‐to‐incision interval for category‐1 caesarean section, but is also associated with worse short term neonatal outcomes. Longer operating room‐to‐incision intervals were not associated with worse neonatal outcomes.