P055: IMPACT OF RACE AND ANESTHESIA PLAN ON CESAREAN SECTION OUTCOMES IN THE UNITED STATES
Matthew Maguire1; Morgan McMasters1; Pura Rodriguez de la Vega, MPH1; Rupa Seetharamaiah, MD, FACS, FASMBS2; Marcia Varella, MD, PhD, MHS1
1FIU HWCOM; 2Baptist Health South Florida
Introduction: Cesarean section (C-section) rates are increasing globally, necessitating a deeper understanding of the impact of anesthetic choice on maternal outcomes. Neuraxial anesthesia has historically been recommended over general anesthesia in obstetrics due to its lower risk of complications, yet the effects of patient-specific factors such as race and comorbidities remain understudied.
Objective: To investigate the relationship between type of anesthesia (general vs. neuraxial) and maternal postoperative complications, and to determine the role of race in this association.
Methods: A secondary analysis of NSQIP data was conducted using data from women undergoing C-sections in the United States from 2019 to 2021. The outcome was a composite of perinatal postoperative complications (infection, blood product transfusion, unplanned readmission, increased length of stay, sepsis, and mortality), compared across the type of anesthesia used. Effect modification by race (Black, White, Hispanic, Asian, and Other) was also assessed. Logistic regression was used to estimate odds ratios (ORs) and adjust for confounders, including BMI, history of hypertension and diabetes, smoking status, emergency C-section, and ASA classification.
Results: Among 7810 women who had C-section, 7.3% received general anesthesia and 92.7% received neuraxial. The overall percentage of complication was 33.7%. About 23.8% of missing data was reported. We found no evidence for effect modification by race. In unadjusted analyses, general anesthesia was associated with higher odds of complications (OR: 1.61, 95% CI 1.35-1.92) compared to neuraxial anesthesia. After risk adjustment, this association between type of anesthesia and perinatal complications was no longer significant. Patient-specific factors such as hypertension (OR: 2.33), history of diabetes (OR: 1.40), emergency C-sections (OR: 2.07), and ASA classification III, IV, or V (OR: 1.84) were associated with higher complications. Black and "Other" ethnicities had 35% and 105% higher odds of complications compared to White patients, respectively (OR: 1.35, 95% CI 1.13-1.61 and OR: 2.05, 95% CI 1.19-3.54 respectively).
Conclusion: Patient-specific factors rather than anesthesia type alone were associated with higher maternal complications following C-section. Future prospective studies are needed to better understand these risks and improve anesthetic management for diverse populations.