Measure ID

Percentage of cesarean delivery cases where general anesthesia was administered after neuraxial anesthesia.

Measure Type
Available for Provider Feedback
No - Departmental Only
Not Applicable - Informational only

General anesthesia is used in roughly 5% of elective cesarean deliveries and 14-20% of emergent cesarean deliveries.1,2 Mothers who receive neuraxial anesthesia report less pain on the day of surgery, show less gastrointestinal stasis, fevers, and coughing on post op day 2, and show earlier mobility and breastfeeding onset than those who receive general anesthesia.3  Mothers who receive general anesthesia during cesarean delivery may also be at increased risk of severe postpartum depression as compared to those who receive neuraxial anesthesia.4

Measure Time Period

Cesarean Delivery cases where neuraxial anesthesia was used.

  • Cesarean delivery cases that use general anesthesia without neuraxial anesthesia.
  • Cesarean Hysterectomies (determined by Obstetric Anesthesia Type value code: 4) 
  • Non-cesarean delivery cases
  • Placenta Accreta cases using the following ICD-10 codes:
    • O43.2, O43.21, O43.22, and O43.22
    • O43.[211, 212, 213, 219, 221, 222, 223, 229, 231, 232, 233, 239]
Success Criteria

Cesarean delivery with neuraxial anesthesia completed without use of general anesthesia.

Other Measure Details

*This measure will include valid MPOG cases defined by the Is Valid Case phenotype.

Risk Adjustment

Not applicable.

Provider Attribution

Departmental only measure - not available for provider feedback emails.

MPOG Concept Used
  • See concepts included in the ‘Obstetric Anesthesia Type’ phenotype and ‘Anesthesia Technique: General’ phenotypes
MPOG Phenotypes Used
  1. Traynor, Andrea J., Meredith Aragon, Debashis Ghosh, Ray S. Choi, Colleen Dingmann, Zung Vu Tran, and Brenda A. Bucklin. 2016. “Obstetric Anesthesia Workforce Survey: A 30-Year Update.” Anesthesia and Analgesia 122 (6): 1939–46.
  2. Juang, Jeremy, Rodney A. Gabriel, Richard P. Dutton, Arvind Palanisamy, and Richard D. Urman. 2017. “Choice of Anesthesia for Cesarean Delivery: An Analysis of the National Anesthesia Clinical Outcomes Registry.” Anesthesia and Analgesia 124 (6): 1914–17.
  3. Morgan, B. M., J. M. Aulakh, J. P. Barker, P. W. Reginald, T. Goroszeniuk, and A. Trojanowski. 1984. “Anaesthetic Morbidity Following Caesarean Section under Epidural or General Anaesthesia.” The Lancet 1 (8372): 328–30.
  4. Guglielminotti, Jean, and Guohua Li. 2020. “Exposure to General Anesthesia for Cesarean Delivery and Odds of Severe Postpartum Depression Requiring Hospitalization.” Anesthesia and Analgesia 131 (5): 1421–29.
Measure Authors
 Measure Author  Institution
 Brooke Szymanski-Bogart, RN  University of Michigan
 Rob Coleman  University of Michigan
 Monica Servin, MD  University of Michigan
 Nirav Shah, MD  University of Michigan
 MPOG OB Subcommittee  


Measure Reviewer(s)
Next Review: 2024
 Date Reviewed  Reviewer  Institution  Summary  QC Vote

 Sharon Abramovitz, MD

 Melinda Mitchell, MD

 Weill Cornell

 Henry Ford Health

 Review  Continue as is


Published Date: 2021
 Date  Criteria  Revision
 7/23/2023  Exclusion  Excludes Placenta Accreta cases based on ICD-10 codes.
 8/10/2021    Initial Publication