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Operating room-to-incision interval and neonatal outcome in emergency caesarean section: a retrospective 5-year cohort study - 12/7/2018

Anaesthesia 2018; 73: 825-31

Introduction and methods

The authors conducted a 5-year retrospective cohort study on women undergoing caesarean section to investigate factors influencing the operating room-to-incision interval. Time-to-event analysis was performed for category-1 caesarean section using a Cox proportional hazards regression model. Covariates included: anaesthetic technique, body mass index, age, parity, time of delivery and gestational age. Binary logistic regression was performed for 5-minute Apgar score =7.


A total of 677 women who underwent category-1 caesarean section and met the entry criteria. Unadjusted median (interquartile range [range]) operating room-to-incision intervals were: epidural top-up 11 (7–17 [0–87]) minutes; general anaesthesia 6 (4–11 [0–69]) minutes; spinal 13 (10–20 [0–83]) minutes; and combined spinal-epidural 24 (13–35 [0–75]) minutes. Cox regression showed general anaesthesia to be the most rapid method, with a hazard ratio (95% confidence interval [CI]) of 1.97 (1.60 to 2.44; p<0.0001), followed by epidural top-up (reference group), spinal anaesthesia 0.79 (0.65 to 0.96; p=0.02) and combined spinal-epidural 0.48 (0.35 to 0.67; p<0.0001). Underweight and overweight body mass indexes were associated with longer operating room-to-incision intervals. General anaesthesia was associated with fewer 5-minute Apgar scores =7, with an odds ratio (95% CI) of 0.28 (0.11 to 0.68; p<0.01). There was no difference in neonatal outcomes between the first and fifth quintiles for operating room-to-incision intervals.



The authors conclude that general anaesthesia is associated with the most rapid operating room-to-incision interval for category-1 caesarean section, but is also associated with worse short-term neonatal outcomes. They point out that longer operating room-to-incision intervals were not associated with worse neonatal outcomes.

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