791: General vs neuraxial anesthesia for cesarean hysterectomy: a secondary analysis

Abstract

The optimal method of anesthesia for cesarean hysterectomy (C-Hyst) due to morbidly adherent placenta (MAP) is uncertain. The objective of this study was to compare maternal and neonatal composite morbidity between planned neuraxial vs general anesthesia in women undergoing a cesarean hysterectomy for MAP. A secondary analysis of the MFMU cesarean registry database (Landon, NEJM 2004) was performed. Group 1 were women who had C-Hyst for MAP under general anesthesia; Group 2, women with planned neuraxial anesthesia. The two primary outcomes were: 1) composite maternal morbidity (CMM) comprised of any of the following: admission to ICU, blood transfusion ≥4 units PRBCs, ureter or bowel injuries, or maternal death; and 2) composite neonatal morbidity (CNM) included any of the following: respiratory distress syndrome, mechanical ventilation, transient tachypnea of the newborn, sepsis, or death. Multivariate logistic regression adjusted for the following confounders: ethnicity and planned delivery, and gestational age at delivery. Adjusted odds ratio (aOR) and 95% confidence intervals (CI) were reported. Among 73,257 women in the database, 133 (0.2%) had a C-Hyst for MAP. There were 54 (41%) women in Group 1 and 79 (59%) in Group 2. Baseline demographics are shown in Table 1. Significant differences were noted in ethnicity, with African American patients more likely to have neuraxial anesthesia and Caucasian patients more likely to receive general anesthesia (p=.03). Planned deliveries were more likely to receive regional anesthesia (p=0.03). After adjusting for significant differences in baseline demographics, no differences were noted in CMM or CNM between groups, shown in Table 2. Composite maternal and neonatal morbidities were similar between the two groups. Until an adequately powered study is done on the topic, the decision to use general vs neuraxial anesthesia should be based on provider’s and woman’s preference.View Large Image Figure ViewerDownload Hi-res image Download (PPT)