This measure is calculated based on data extracted from the electronic medical record combined with administrative data sources such as professional fee and discharge diagnoses data.  This measure is explicitly not based on provider self-attestation.

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

Neuraxial Start to Anesthesia End 

• Cesarean Delivery cases where neuraxial anesthesia was used
  • Cesarean Delivery cases as determined by the “Obstetric Anesthesia Type” Phenotype. Phenotype results included:
    • Cesarean Delivery
    • Conversion (Cesarean Delivery Portion)
    • Conversion (Labor epidural and cesarean delivery combined)
  • Neuraxial anesthesia use is determined by the ‘Anesthesia Technique Neuraxial’ phenotype. Results included:
    • Combined Spinal Epidural (CSE)
    • Epidural
    • Spinal
    • Caudal
    • Neuraxial - unknown type
    • Neuraxial - multiple types listed

• Cesarean Hysterectomies as determined by the “Obstetric Anesthesia Type” Phenotype. 
• Cesarean delivery cases that only use general anesthesia without neuraxial anesthesia
• Non-cesarean delivery cases

Cesarean delivery with neuraxial anesthesia completed without use of general anesthesia

• Use of general anesthesia is determined by the ‘Anesthesia Technique: General’ phenotype
• Time of general anesthesia administration is defined as the time of the earliest flag considered by the ‘Anesthesia Technique: General’ phenotype or 2004 ‘intrathecal’ medication route
• Use of neuraxial anesthesia is determined by the ‘Anesthesia Technique: Neuraxial’ phenotype
• The start time of neuraxial anesthesia is determined by the ‘Obstetric Neuraxial Anesthesia Start Time’ phenotype. 
• Cases where ‘measure end’ precedes ‘measure start’ will be excluded from the measure

n/a, departmental only measure

• See concepts included in the ‘Obstetric Anesthesia Type’ phenotype and ‘Anesthesia Technique: General’ phenotypes

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

N/A

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.