Top

Canadian Journal of Anesthesia/Journal canadien d'anesthésie

Published in:

01-01-2022 | General Anesthesia | Reports of Original Investigations

Anesthesia-related adverse events in obstetric patients: a population-based study in Canada

Authors: Leyla Baghirzada, MD, MPH, David Archer, MD, Andrew Walker, PhD, Mrinalini Balki, MBBS, MD

Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 1/2022

Abstract

Background

Anesthesia-related complications in obstetric patients could be catastrophic and impact the lives of both the parturient and the neonate. The objective of this study was to determine the frequency, temporal trend, and risk factors of anesthesia-related adverse events during hospitalization for delivery in Canada.

Methods

This retrospective population-based study utilized the hospitalization database of the Canadian Institute for Health Information for all parturients (gestation ≥ 20 weeks) in Canada (except Quebec) hospitalized for childbirth from April 2004 to March 2017. Complications were identified by the enhanced Canadian version of the tenth revision of the International Statistical Classification of Diseases and Related Health Problems codes. Data were summarized with descriptive statistics. Associations between hospitalizations with an anesthesia-related adverse event and patient characteristics, delivery method, and modality of anesthesia were assessed using multivariate logistic regression.

Results

Among 2,601,034 hospitalizations (3,194,875 interventions), 8,361 anesthesia-related adverse events occurred over a 13-year period (262 per 100,000 interventions; 95% confidence interval [CI], 256 to 267), with a significant decline over time (P < 0.001). These were two-fold and seven-fold higher per 100,000 interventions with general (488; 95% CI, 438 to 542) and general plus neuraxial (1,476; 95% CI, 1,284 to 1,689) anesthesia compared with neuraxial anesthesia alone (225; 95% CI, 219 to 230). Serious adverse events constituted 9% of all adverse events. The most common adverse event was spinal and epidural anesthesia-induced headache (6,908/8,361; 83%); the overall rate of failed or difficult intubations was low (201/8,361; 2%). Anesthesia-related events were more likely in those who had a Cesarean delivery compared with vaginal delivery (odds ratio [OR], 1.12; 95% CI, 1.06 to 1.18) and general anesthesia compared with neuraxial anesthesia (OR, 1.71; 95% CI, 1.53 to 1.93). Noteworthy associations were found between any anesthesia-related adverse events and cardiomyopathy (OR, 8.34; 95% CI, 2.59 to 26.83), eclampsia (OR, 3.11; 95% CI, 1.95 to 4.97), and obstructive sleep apnea (OR, 1.91; 95% CI, 1.66 to 2.19).

Conclusion

The incidence of anesthesia-related adverse events in obstetric patients in Canada is low and declining. High vigilance is required in parturients undergoing Cesarean delivery, receiving general anesthesia, and those with pre-existing medical conditions.

Available only for authorised users

BK Ross 2003 ASA closed claims in obstetrics: lessons learned Anesthesiol Clin North Am 21 183 197PubMedCrossRef

W Stones W Lim F Al-Azzawi M Kelly 1991 An investigation of maternal morbidity with identification of life-threatening ‘near miss’ episodes Health Trends 23 13 15PubMed

IS Haj El M Fridman LM Korst KD Gregory 2014 Anesthesia complications as a childbirth patient safety indicator Anesth Analg 119 911 917CrossRef

JG Jenkins 2005 Some immediate serious complications of obstetric epidural analgesia and anaesthesia: a prospective study of 145,550 epidurals Int J Obstet Anesth 14 37 42PubMedCrossRef

A Holdcroft FB Gibberd RL Hargrove DF Hawkins CI Dellaportas 1995 Neurological complications associated with pregnancy Br J Anaesth 75 522 526PubMedCrossRef

DB Scott ME Tunstall 1995 Serious complications associated with epidural/spinal blockade in obstetrics: a two-year prospective study Int J Obstet Anesth 4 133 139PubMedCrossRef

DB Scott BM Hibbard 1990 Serious non-fatal complications associated with extradural block in obstetric practice Br J Anaesth 64 537 541PubMedCrossRef

JG Jenkins 1998 Complications of obstetric epidurals: an audit of 10,817 cases Int J Obstet Anesth 7 280 281PubMedCrossRef

MJ Paech R Godkin S Webster 1998 Complications of obstetric epidural analgesia and anaesthesia: a prospective analysis of 10,995 cases Int J Obstet Anesth 7 5 11PubMedCrossRef

10.

M Palot H Visseaux C Botmans JC Pire 1994 Epidemiology of complications of obstetrical epidural analgesia (French) Cah Anesthesiol 42 229 233PubMed

11.

JS Crawford 1985 Some maternal complications of epidural analgesia for labour Anaesthesia 40 1219 1225PubMedCrossRef

12.

W Ruppen S Derry H McQuay RA Moore 2006 Incidence of epidural hematoma, infection, and neurologic injury in obstetric patients with epidural analgesia/anesthesia Anesthesiology 105 394 399PubMedCrossRef

13.

A Holdcroft M Morgan 1976 Maternal complications of obstetric epidural analgesia Anaesth Intensive Care 4 108 112PubMedCrossRef

14.

Bloom SL, Spong CY, Weiner SJ, et al.; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Complications of anesthesia for cesarean delivery. Obstet Gynecol 2005; 106: 281-7.

15.

H Chadwick 1996 An analysis of obstetric anesthesia cases from the American society of anesthesiologists closed claims project database Int J Obstet Anesth 5 258 263PubMedCrossRef

16.

R D'Angelo RM Smiley ET Riley S Segal 2014 Serious complications related to obstetric anesthesia: the serious complication repository project of the Society for Obstetric Anesthesia and Perinatology Anesthesiology 120 1505 1512PubMedCrossRef

17.

K Cheesman J Brady P Flood G Li 2009 Epidemiology of anesthesia-related complications in labor and delivery, New York State, 2002–2005 Anesth Analg 109 1174 1181PubMedPubMedCentralCrossRef

18.

M Balki S Liu JA Leon L Baghirzada 2017 Epidemiology of cardiac arrest during hospitalization for delivery in Canada: a nationwide study Anesth Analg 124 890 897PubMedCrossRef

19.

V Beckett M Knight P Sharpe 2017 The CAPS Study: incidence, management and outcomes of cardiac arrest in pregnancy in the UK: a prospective, descriptive study BJOG 124 1374 1381PubMedCrossRef

20.

K Joseph S Liu J Rouleau 2010 Severe maternal morbidity in Canada, 2003–2007: surveillance using routine hospitalization data and ICD-10-CA codes J Obstet Gynaecol Can 32 837 846PubMedCrossRef

21.

Knight M, Nair M, Tuffnell D, et al. Surveillance of maternal deaths in the UK 2012-14 and lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009-14. Available from URL: https://www.npeu.ox.ac.uk/mbrrace-uk/reports/confidential-enquiry-into-maternal-deaths (accessed July 2021).

22.

Centers for Disease Control and Prevention. Pregnancy Mortality Surveillance System. Available from URL: https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm (accessed July 2021).

23.

SS Wen S Liu S Marcoux D Fowler 1997 Uses and limitations of routine hospital admission/separation records for perinatal surveillance Chronic Dis Can 18 113 119PubMed

24.

Canadian Institute for Health Information. International Statistical Classification of Diseases and Related Health Problems. 10th Revision. Volume 1; 2009.

25.

Canadian Institute for Health Information. Canadian Classification of Health Interventions. Volume 3; 2009.

26.

Davies GA, Maxwell C, McLeod L; Maternal Fetal Medicine Committee; Clinical Practice Obstetrics. Obesity in pregnancy. J Obstet Gynaecol Can 2010; 32: 165-73.

27.

A Martin M Monsour DM Kissin DJ Jamieson WM Callaghan SL Boulet 2016 Trends in severe maternal morbidity after assisted reproductive technology in the United States, 2008–2012 Obstet Gynecol 127 59 66PubMedCrossRef

28.

S Dzakpasu P Deb-Rinker L Arbour 2019 Severe maternal morbidity in Canada: temporal trends and regional variations, 2003–2016 J Obstet Gynaecol Can 41 1589 98.e16PubMedCrossRef

29.

BA Bucklin JL Hawkins JR Anderson FA Ullrich 2005 Obstetric anesthesia workforce survey: twenty-year update Anesthesiology 103 645 653PubMedCrossRef

30.

L Hawthorne R Wilson G Lyons M Dresner 1996 Failed intubation revisited: 17-yr experience in a teaching maternity unit Br J Anaesth 76 680 684PubMedCrossRef

31.

SM Kinsella AL Winton MC Mushambi 2015 Failed tracheal intubation during obstetric general anaesthesia: a literature review Int J Obstet Anesth 24 356 374PubMedCrossRef

32.

EA Djabatey PM Barclay 2009 Difficult and failed intubation in 3430 obstetric general anaesthetics Anaesthesia 64 1168 1171PubMedCrossRef

33.

Reale S, Aziz M, Bateman B, Bateman B, Kheterpal S, Klumpnr T. The frequency of difficult intubation in obstetric patients: a study from the Multicenter Perioperative Outcomes Group Research Consortium. SOAP Virtual Meeting Series 2020; BCPS-05 (abstract).

34.

JM Davies KL Posner LA Lee FW Cheney KB Domino 2009 Liability associated with obstetric anesthesia: a closed claims analysis Anesthesiology 110 131 139PubMedCrossRef

35.

AR Moore PM Wieczorek JC Carvalho 2020 Association between post-dural puncture headache after neuraxial anesthesia in childbirth and intracranial subdural hematoma JAMA Neurol 77 65 72PubMedCrossRef

36.

EB Rosero GP Joshi 2016 Nationwide incidence of serious complications of epidural analgesia in the United States Acta Anaesthesiol Scand 60 810 820PubMedCrossRef

37.

V Moen N Dahlgren L Irestedt 2004 Severe neurological complications after central neuraxial blockades in Sweden 1990–1999 Anesthesiology 10 950 959CrossRef

38.

SE Lapinsky 2015 Acute respiratory failure in pregnancy Obstet Med 8 126 132PubMedPubMedCentralCrossRef

39.

JM Mhyre MN Riesner LS Polley NN Naughton 2007 A series of anesthesia-related maternal deaths in Michigan, 1985–2003 Anesthesiology 106 1096 1104PubMedCrossRef

40.

SA Thorne 2004 Pregnancy in heart disease Heart 90 450 456PubMedPubMedCentralCrossRef

41.

European Society of Gynecology (ESG); Association for European Paediatric Cardiology (AEPC); German Society for Gender Medicine (DGesGM); Regitz‐Zagrosek V, Lundqvist CB, Borghi C, et al. European Society of Cardiology Guidelines on the management of cardiovascular diseases during pregnancy: the Task Force on the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC). Eur Heart J 2011; 32: 3147-97.

42.

JW Roos-Hesselink TP Ruys JI Stein 2013 Outcome of pregnancy in patients with structural or ischaemic heart disease: results of a registry of the European Society of Cardiology Eur Heart J 34 657 665PubMedCrossRef

43.

GC Endler FG Mariona RJ Sokol LB Stevenson 1988 Anesthesia-related maternal mortality in Michigan, 1972 to 84 Am J Obstet Gynecol 159 187 193PubMedCrossRef

44.

Cooper GM, McClure JH. Anaesthesia. In: Why Mothers Die, 2000–2002. Sixth report on confidential enquiries into maternal deaths in the United Kingdom. London: RCOG press; 2004: 122-33.

45.

AF Saftlas DR Olson AL Franks HK Atrash R Polaras 1990 Epidemiology of preeclampsia and eclampsia in the United States, 1979–1986 Am J Obstet Gynecol 163 460 465PubMedCrossRef

46.

B Moller G Lindmark 1986 Eclampsia in Sweden, 1976–1980 Acta Obstet Gynecol Scand 65 307 314PubMedCrossRef

47.

KA Douglas CW Redman 1994 Eclampsia in the United Kingdom BMJ 309 1395 1400PubMedPubMedCentralCrossRef

48.

Cantwell R, Clutton‐Brock T, Cooper G, et al. Saving Mothers’ Lives: reviewing maternal deaths to make motherhood safer: 2006–2008. The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG 2011; 118: 1-203.

49.

Joseph KS, Fahey J; Canadian Perinatal Surveillance System. Validation of perinatal data in the Discharge Abstract Database of the Canadian Institute for Health Information. Chronic Dis Can 2009; 29: 96-100.

50.

S Liu KS Joseph S Bartholomew 2010 Temporal trends and regional variations in severe maternal morbidity in Canada 2003 to 2007 J Obstet Gynaecol Can 32 847 855PubMedCrossRef

51.

Kramer MS, Rouleau J, Liu S, Bartholomew S, Joseph KS; Maternal Health Study Group of the Canadian Perinatal Surveillance System. Amniotic fluid embolism: incidence, risk factors, and impact on perinatal outcome. BJOG 2012; 119: 874-9.

Title: Anesthesia-related adverse events in obstetric patients: a population-based study in Canada
Authors: Leyla Baghirzada, MD, MPH
David Archer, MD
Andrew Walker, PhD
Mrinalini Balki, MBBS, MD
Publication date: 01-01-2022
Publisher: Springer International Publishing
Keyword: General Anesthesia
Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Issue 1/2022
Print ISSN: 0832-610X
Electronic ISSN: 1496-8975
DOI: https://doi.org/10.1007/s12630-021-02101-3

At a glance: The STEP trials

Springer Medicine

Anesthesia-related adverse events in obstetric patients: a population-based study in Canada

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2022

Guidelines to the Practice of Anesthesia – Revised Edition 2022

Code Red will become Code Blue for humanity: an urgent call for action in the anesthesia community

Iron supplementation for patients undergoing cardiac surgery: a systematic review and meta-analysis of randomized controlled trials

Fluid management for kidney transplantation: is it really about more or less?

A comparison of patient and provider perceptions of awake tracheal intubations

Comparison of analgesic modalities for patients undergoing midline laparotomy: a systematic review and network meta-analysis