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Hospital practice more than specialty influences the choice of regional or general anesthesia for Cesarean section

[La pratique hospitalière influence plus que la spécialité dans le choix de l’anesthésie régionale ou générale pour la césarienne]

David Johnson, MD SM MBA^* and Corrine Truman, PhD

^* Form the Department of Critical Care Medicine, University of Alberta; and
the Health Service Utilization, Alberta Health and Wellness, Edmonton, Alberta, Canada.

Address correspondence to: Dr. David Johnson, Professor of Critical Care Medicine, University of Alberta, 3C1 WMC, Edmonton, Alberta T6G 2B7, Canada. E-mail: cujecjohnson{at}shaw.ca

Purpose: Describe the influence of specialty certification and practice style upon the anesthetic technique used for Cesarean deliveries.

Methods: Alberta physician claims and hospital abstracts between April 1, 1998 to March 31, 2000 were used to determine the technique of anesthesia (regional or general). The influence of practice (volume of deliveries, geographic location, presence of regional analgesia providers) and specialty (anesthesiologist or family/general practice) is explored by logistic regression.

Results: Hospital abstracts of 13,884 Cesarean sections were analyzed. Anesthesiologists performed 76% of the anesthetics: epidural (33%), spinal (45%), and general anesthesia (22%). Comparing only regional and metropolitan hospitals, the percent of general anesthesia performed by anesthesiologists varied between 5% to 50%. After adjusting for other factors, we found, in order of importance, the following determined the use of general anesthesia for Cesarean sections: 1) hospitals with more epidural procedure providers during labour were 3% less likely to have providers choose general anesthesia; 2) larger, regional and metropolitan hospitals were less likely to have providers choose general anesthesia; 3) hospitals with a high volume epidural procedure provider during labour were 64% less likely to have providers choose general anesthesia; 4) anesthesiologists were 32% less likely to choose general anesthesia.

Conclusion: The overall use of regional anesthesia for Cesarean sections in Alberta is high. The chance of receiving a general anesthetic for a Cesarean delivery varies across the province and was more related to practice environment than specialty.