Epidemiology of anesthesia-related complications in labor and delivery, New York State, 2002-2005.
BACKGROUND
Epidemiologic data on anesthesia-related complications occurring during labor and delivery are essential for measuring and evaluating the safety and quality of obstetric anesthesia care but are lacking. We aimed to fill this research gap by exploring the epidemiologic patterns and risk factors of anesthesia-related complications in a large sample of women giving birth in New York hospitals.


METHODS
Using the Healthcare Cost and Utilization Project State Inpatient Databases files, we identified all discharge records for labor and delivery from New York hospitals between 2002 and 2005. We then identified women who experienced any recorded anesthesia-related complication during labor and delivery as determined by International Classification of Diseases, Ninth Revision, Clinical Modification codes. The incidence of anesthesia-related complications was calculated by demographic and clinical characteristics. Multivariate logistic regression was performed to assess risk factors of anesthesia-related complications.


RESULTS
Of the 957,471 deliveries studied, 4438 (0.46%) had at least one anesthesia-related complication. The majority (55%) of anesthesia-related events occurring during labor and delivery were spinal complications, followed by systemic complications (43%) and overdose or adverse effects (2%). Multivariate logistic regression revealed five risk factors of anesthesia-related complications: cesarean delivery (odds ratio [OR] 2.51, 95% confidence interval [CI] 2.36-2.68), rural area (OR 1.33, 95% CI 1.21-1.46), Charlson-Deyo Comorbidity Index >or=1 (OR 1.47, 95% CI 1.28-1.69), Caucasian race (OR 1.37, 95% CI 1.24-1.52), and scheduled admission (OR 1.10, 95% CI 1.03-1.18). Anesthesia-related complications were associated with about a one-day increase in the average length of stay (3.89 +/- 3.69 [mean +/- SD] days vs 2.92 +/- 2.38 days for deliveries without anesthesia-related complications, P < 0.0001) and a 22-fold increased risk of maternal mortality (OR 22.26, 95% CI 11.20-44.24).


CONCLUSIONS
The incidence of anesthesia-related complications during labor and delivery seems to be low but remains a cause of concern, particularly in women undergoing cesarean delivery, living in rural areas, or having preexisting medical conditions.
Cheesman
Khadeen
K
Department of Anesthesiology, Columbia University, 622 West 168th St., PH5-505, New York, NY 10032, USA.
Brady
Joanne E
JE
Flood
Pamela
P
Li
Guohua
G
D000293:Adolescent; D000328:Adult; D000773:Anesthesia, Obstetrical / Q000009:adverse effects* / Q000401:mortality; D002585:Cesarean Section / Q000009:adverse effects; D002648:Child; D015897:Comorbidity; D036861:Delivery, Obstetric / Q000401:mortality / Q000706:statistics & numerical data*; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D006780:Hospitals, Rural / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D007744:Obstetric Labor Complications / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D016017:Odds Ratio; D010351:Patient Discharge / Q000706:statistics & numerical data; D011247:Pregnancy; D012111:Residence Characteristics / Q000706:statistics & numerical data; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult