Abstract
BackgroundThe cost-benefit of stocking dantrolene in maternity units for treating malignant hyperthermia (MH) has been recently questioned because of the low incidence of MH crisis in the general population and the low utilization of general anesthesia in obstetrics. However, no study has examined the prevalence of MH susceptibility in obstetrics. This study aimed to assess the prevalence of MH diagnosis and associated factors in obstetric patients.MethodsData for this study came from the National Inpatient Sample from 2003 to 2014, a 20% nationally representative sample of discharge records from community hospitals. A diagnosis of MH due to anesthesia was identified using the International Classification of Diseases, Ninth Revision, Clinical Modification code 995.86. MH prevalence was estimated according to the delivery mode and patient and hospital characteristics.ResultsDuring the 12-year study period, 47,178,322 delivery-related discharges [including 15,175,127 (32.2%) cesarean deliveries] were identified. Of them, 215 recorded a diagnosis of MH, yielding a prevalence of 0.46 per 100,000 [95% confidence interval (CI), 0.40 to 0.52]. The prevalence of MH diagnosis in cesarean deliveries was 0.81 per 100,000 (95% CI, 0.67 to 0.97), compared with 0.29 per 100,000 (95% CI, 0.23 to 0.35) in vaginal deliveries (P < 0.001). Multivariable logistic regression revealed that cesarean delivery was associated with a significantly increased risk of MH diagnosis [adjusted rate ratio (aOR) 2.88; 95% CI, 2.19 to 3.80]. Prevalence of MH diagnosis was lower in Hispanics than in non-Hispanic whites (aOR 0.47; 95% CI, 0.29 to 0.76) and higher in the South than in the Northeast census regions (aOR 2.44; 95% CI, 1.50 to 3.96).ConclusionThe prevalence of MH-susceptibility is about 1 in 125,000 in cesarean deliveries, similar to the prevalence reported in non-obstetrical surgery inpatients. The findings of this study suggest that stocking dantrolene in maternity units is justified.
Highlights
The cost-benefit of stocking dantrolene in maternity units for treating malignant hyperthermia (MH) has been recently questioned because of the low incidence of MH crisis in the general population and the low utilization of general anesthesia in obstetrics
A diagnosis of MH was recorded in 26 cases, yielding a prevalence of 0.81 per 100,000
A diagnosis of MH was recorded in 20 cases, yielding a prevalence of 0.29 per 100,000
Summary
The cost-benefit of stocking dantrolene in maternity units for treating malignant hyperthermia (MH) has been recently questioned because of the low incidence of MH crisis in the general population and the low utilization of general anesthesia in obstetrics. This study aimed to assess the prevalence of MH diagnosis and associated factors in obstetric patients. Malignant hyperthermia (MH) is a pharmacogenetic disorder of the skeletal muscle triggered by halogenated inhalational agents or the depolarizing muscle relaxant succinylcholine [1, 2]. The low frequency of MH crises and the cost of stocking dantrolene have given rise to concern about the cost-benefit of the recommendation of the Malignant Hyperthermia Association of the United States (MHAUS) that dantrolene be made immediately available (for administration within 10 min) in operating room areas, especially in facilities with a low utilization of general anesthesia and triggering agents such as maternity units [10, 11]. No study has examined the prevalence of MH susceptibility in obstetric patients [12]
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