Current Epidemiology of the General Anesthesia Practice for Cesarean Delivery Using a Nationwide Claims Database in Japan: A Descriptive Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Source
2.2. Study Population
2.3. Patient- and Facility-Level Variables
2.4. Outcomes
2.5. Statistical Analysis
3. Results
3.1. Study Cohort
3.2. Patient and Medical Facility Characteristics
3.3. Trends in the Rate of General Anesthesia Use
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristic | L008 with NMBA, n = 2992 | L008 without NMBA, n = 7980 | Absolute SMD (%) |
---|---|---|---|
Age, year | 5.0 | ||
Mean ± SD | 33.4 ± 5.1 | 33.1 ± 4.9 | |
<35 | 1826 (61.0) | 5060 (63.4) | 4.9 |
35–39 | 869 (29.0) | 2241 (28.1) | 2.1 |
40–44 | 266 (8.9) | 616 (7.7) | 4.2 |
>44 | 31 (1.0) | 63 (0.8) | 2.6 |
Maternal Comorbidity Index | |||
Alcohol abuse | 2 (0.1) | 2 (0.0) | 1.9 |
Asthma | 241 (8.1) | 616 (7.7) | 1.2 |
Cardiac valvular disease | 23 (0.8) | 16 (0.2) | 8.2 |
Chronic congestive heart failure | 5 (0.2) | 1 (0.0) | 5.2 |
Chronic ischemic heart disease | 32 (1.1) | 27 (0.3) | 8.8 |
Chronic renal disease | 26 (0.9) | 26 (0.3) | 7.1 |
Congenital heart disease | 24 (0.8) | 15 (0.2) | 8.8 |
Drug abuse | 0 (0) | 0 (0) | |
Gestational hypertension | 32 (1.1) | 51 (0.6) | 4.7 |
Human immunodeficiency virus | 0 (0) | 0 (0) | |
Mild/unspecified pre-eclampsia | 113 (3.8) | 246 (3.1) | 3.8 |
Multiple gestation | 120 (4.0) | 198 (2.5) | 8.6 |
Placenta previa | 270 (9.0) | 374 (4.7) | 17.2 |
Pre-existing diabetes mellitus | 41 (1.4) | 40 (0.5) | 9.0 |
Pre-existing hypertension | 88 (2.9) | 106 (1.3) | 11.2 |
Previous cesarean delivery | 193 (6.5) | 938 (11.8) | 18.5 |
Pulmonary hypertension | 4 (0.1) | 0 (0) | 5.2 |
Severe pre-eclampsia | 111 (3.7) | 246 (3.1) | 3.5 |
Sickle cell disease | 0 (0) | 0 (0) | |
Systemic lupus erythematosus | 21 (0.7) | 13 (0.2) | 8.2 |
Maternal Comorbidity Index score, median (IQR) | 1 (0–2) | 1 (0–1) | |
0 | 1298 (43.4) | 3767 (47.2) | 7.7 |
1–2 | 1237 (41.3) | 3407 (42.7) | 2.7 |
>2 | 457 (15.3) | 806 (10.1) | 15.6 |
Obstetrical/maternal/fetal emergency | |||
Amniotic fluid embolism | 8 (0.3) | 0 (0) | 7.3 |
Chorioamnionitis | 287 (9.6) | 418 (5.2) | 16.7 |
Fetal distress | 675 (22.6) | 1260 (15.8) | 17.3 |
Obstetric hemorrhage | 8 (0.3) | 8 (0.1) | 3.9 |
Placental abruption | 375 (12.5) | 87 (1.1) | 46.6 |
Placenta accreta | 51 (1.7) | 27 (0.3) | 13.6 |
Placental dysfunction | 353 (11.8) | 476 (6.0) | 20.6 |
Umbilical cord prolapse | 70 (2.3) | 102 (1.3) | 8.0 |
Uterine rupture | 20 (0.7) | 12 (0.2) | 8.1 |
Type of cesarean delivery | |||
Elective (K898-2) | 1093 (36.5) | 5343 (67.0) | 63.9 |
Emergency (K898-1) | 1726 (57.7) | 2575 (32.3) | 52.8 |
Cesarean delivery with placenta previa or preterm birth (K898-3) * | 173 (5.8) | 62 (0.8) | 28.4 |
Fiscal year | |||
2005–2009 | 231 (7.7) | 626 (7.8) | 0.5 |
2010–2014 | 874 (29.2) | 2588 (32.4) | 7.0 |
2015–2020 | 1887 (63.1) | 4766 (59.7) | 6.9 |
Number of beds | |||
0–19 | 520 (17.4) | 4047 (50.7) | 75.1 |
20–99 | 346 (11.6) | 1429 (17.9) | 18.0 |
100–199 | 48 (1.6) | 227 (2.8) | 8.4 |
200–299 | 81 (2.7) | 358 (4.5) | 9.6 |
300–499 | 419 (14.0) | 1152 (14.4) | 1.2 |
>499 | 1578 (52.7) | 767 (9.6) | 105.2 |
Academic hospital | 656 (21.9) | 174 (2.2) | 63.6 |
DPC payment system hospital | 2109 (70.5) | 2380 (29.8) | 89.0 |
L008 with NMBAs, n = 2992 | L008 without NMBAs, n = 7980 | Absolute SMD (%) | |
---|---|---|---|
NMBAs * | 2992 (100) | 0 (0) | |
Rocuronium | 2349 (78.5) | 0 (0) | 270.3 |
Suxamethonium | 1014 (33.9) | 0 (0) | 101.2 |
Vecuronium | 298 (10.0) | 0 (0) | 47.0 |
Pancuronium | 36 (1.2) | 0 (0) | 15.6 |
Anesthetics | |||
Propofol | 1855 (62.0) | 3425 (42.9) | 38.9 |
Barbiturate | 1422 (47.5) | 326 (4.1) | 114.3 |
Benzodiazepine | 391 (13.1) | 1487 (18.6) | 15.3 |
Volatile halogenated agents | 2030 (67.8) | 1202 (15.1) | 126.9 |
Nitrous oxide | 1237 (41.3) | 5064 (63.5) | 45.4 |
Ketamine | 212 (7.1) | 791 (9.9) | 10.1 |
Analgesics | |||
Fentanyl | 2040 (68.2) | 2951 (37.0) | 65.8 |
Remifentanil | 1447 (48.4) | 15 (0.2) | 135.8 |
Morphine (any route) | 239 (8.0) | 1171 (14.7) | 21.2 |
Local anesthetic for spinal anesthesia | 423 (14.1) | 5103 (63.9) | 118.7 |
Bupivacaine for spinal anesthesia | 410 (13.7) | 4637 (58.1) | 104.4 |
Local anesthetic for epidural anesthesia | 1032 (34.5) | 4463 (55.9) | 44.1 |
2% Lidocaine | 85 (2.8) | 602 (7.5) | 21.3 |
2% Mepivacaine | 65 (2.2) | 1154 (14.5) | 45.6 |
Ropivacaine | 728 (24.3) | 3012 (37.7) | 29.3 |
Levobupivacaine | 232 (7.8) | 378 (4.7) | 12.5 |
Bupivacaine, excluding for spinal anesthesia | 46 (1.5) | 881 (11.0) | 39.9 |
Code L003: continuous infusion of local anesthetic after epidural anesthesia | 349 (11.7) | 3105 (38.9) | 66.0 |
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Yonekura, H.; Mazda, Y.; Noguchi, S.; Tsunobuchi, H.; Shimaoka, M. Current Epidemiology of the General Anesthesia Practice for Cesarean Delivery Using a Nationwide Claims Database in Japan: A Descriptive Study. J. Clin. Med. 2022, 11, 4808. https://doi.org/10.3390/jcm11164808
Yonekura H, Mazda Y, Noguchi S, Tsunobuchi H, Shimaoka M. Current Epidemiology of the General Anesthesia Practice for Cesarean Delivery Using a Nationwide Claims Database in Japan: A Descriptive Study. Journal of Clinical Medicine. 2022; 11(16):4808. https://doi.org/10.3390/jcm11164808
Chicago/Turabian StyleYonekura, Hiroshi, Yusuke Mazda, Shohei Noguchi, Hironaka Tsunobuchi, and Motomu Shimaoka. 2022. "Current Epidemiology of the General Anesthesia Practice for Cesarean Delivery Using a Nationwide Claims Database in Japan: A Descriptive Study" Journal of Clinical Medicine 11, no. 16: 4808. https://doi.org/10.3390/jcm11164808
APA StyleYonekura, H., Mazda, Y., Noguchi, S., Tsunobuchi, H., & Shimaoka, M. (2022). Current Epidemiology of the General Anesthesia Practice for Cesarean Delivery Using a Nationwide Claims Database in Japan: A Descriptive Study. Journal of Clinical Medicine, 11(16), 4808. https://doi.org/10.3390/jcm11164808