Your browser doesn't support javascript.
loading
Variation in Hospital Neuraxial Labor Analgesia Rates in California.
Parameshwar, Pooja; Guo, Nan; Bentley, Jason; Main, Elliot; Singer, Sara J; Peden, Carol J; Morris, Theresa; Ansari, Jessica; Butwick, Alexander J.
Afiliação
  • Parameshwar P; Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah.
  • Guo N; Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California.
  • Bentley J; Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, Australia.
  • Main E; Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California; and California Maternal Quality Care Collaborative, Stanford, California.
  • Singer SJ; Department of Medicine, Stanford University School of Medicine, Stanford, California.
  • Peden CJ; Department of Anesthesiology, Keck School of Medicine, University of Southern California, Los Angeles, California; Department of Anesthesiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
  • Morris T; Department of Sociology, Texas A&M University, College Station, Texas.
  • Ansari J; Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California.
  • Butwick AJ; Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California.
Anesthesiology ; 140(6): 1098-1110, 2024 Jun 01.
Article em En | MEDLINE | ID: mdl-38412054
ABSTRACT

BACKGROUND:

Neuraxial analgesia provides effective pain relief during labor. However, it is unclear whether neuraxial analgesia prevalence differs across U.S. hospitals. The aim of this study was to assess hospital variation in neuraxial analgesia prevalence in California.

METHODS:

A retrospective cross-sectional study analyzed birthing patients who underwent labor in 200 California hospitals from 2016 to 2020. The primary exposure was the delivery hospital. The outcomes were hospital neuraxial analgesia prevalence and between-hospital variability, before and after adjustment for patient and hospital factors. Median odds ratio and intraclass correlation coefficients quantified between-hospital variability. The median odds ratio estimated the odds of a patient receiving neuraxial analgesia when moving between hospitals. The intraclass correlation coefficients quantified the proportion of the total variance in neuraxial analgesia use due to variation between hospitals.

RESULTS:

Among 1,510,750 patients who underwent labor, 1,040,483 (68.9%) received neuraxial analgesia. Both unadjusted and adjusted hospital prevalence exhibited a skewed distribution characterized by a long left tail. The unadjusted and adjusted prevalences were 5.4% and 6.0% at the 1st percentile, 21.0% and 21.2% at the 5th percentile, 70.6% and 70.7% at the 50th percentile, 75.8% and 76.6% at the 95th percentile, and 75.9% and 78.6% at the 99th percentile, respectively. The adjusted median odds ratio (2.3; 95% CI, 2.1 to 2.5) indicated substantially increased odds of a patient receiving neuraxial analgesia if they moved from a hospital with a lower odds of neuraxial analgesia to one with higher odds. The hospital explained only a moderate portion of the overall variability in neuraxial analgesia (intraclass correlation coefficient, 19.1%; 95% CI, 18.8 to 20.5%).

CONCLUSIONS:

A long left tail in the distribution and wide variation exist in the neuraxial analgesia prevalence across California hospitals that is not explained by patient and hospital factors. Addressing the low prevalence among hospitals in the left tail requires exploration of the interplay between patient preferences, staffing availability, and care providers' attitudes toward neuraxial analgesia.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Analgesia Obstétrica Limite: Adult / Female / Humans / Pregnancy País/Região como assunto: America do norte Idioma: En Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Analgesia Obstétrica Limite: Adult / Female / Humans / Pregnancy País/Região como assunto: America do norte Idioma: En Ano de publicação: 2024 Tipo de documento: Article