Epidemiology of Anesthesia-Related Complications in Labor and Delivery, New York State, 2002-2005

Abstract

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 ≥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). CONCLUSION 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.

Maternal morbidity during childbirth hospitalization in California

“…We identified maternal morbidity using International Classification of Diseases, 9 th Revision (ICD-9-CM) diagnosis and procedure codes[7,8,16-20] supplemented with birth certificate data. [21] (Supplementary Digital Content S1) After determining crude rates of morbidities for each year we classified women as having “pelvic floor morbidity,” “non-pelvic floor morbidity,” and “severe morbidity.” Mothers were considered positive for “pelvic floor morbidity” if they had ICD-9 codes for episiotomy, 3 rd or 4 th degree laceration, vulvar or perineal hematoma or other trauma; or indication of 3 rd or 4 th degree laceration on the birth certificate.…”

Effect of time of birth on maternal morbidity during childbirth hospitalization in California

“…Studies of coding accuracy for the types of outcomes reported here suggest that any systematic bias present would be toward under-reporting, rather than over-reporting, of morbidity. 40-42 While there are limitations to restricting our analysis to one state and limitations to what variables can be analyzed using administrative data, California has robust data for childbirth cohorts and accounts for over 12% of US births. 43 The size of the annual birth cohort allows for analysis of rare outcomes over a relatively short period of time.…”

Development and Evaluation of a Score to Predict Difficult Epidural Placement During Labor

“…Dural puncture remains the most frequent complication of epidural placement during labor. 3 It may compromise the quality of the postpartum period and lead to liability claims. 4,5 Five risk factors for difficult neuraxial block have been reported in the literature: difficult palpation of bony landmarks, obesity, spinal deformity, inability of the patient to flex his/her back, and operator's low level of experience.…”