A study of factors influencing surgical cesarean delivery times in an academic tertiary center

Abstract

Background: Knowledge of hospital-specific average cesarean delivery operative times, and factors influencing length of surgery, can serve as a guide for anesthesiologists when choosing the optimal anesthetic technique. The aim of this study was to determine operative times and the factors influencing those times for cesarean delivery.

Methods: We conducted a retrospective review of all 1348 cesarean deliveries performed at an academic hospital in 2011. The primary outcome was mean operative time for first, second, third and fourth or more cesarean deliveries. The secondary goal was to identify factors influencing operative time. Variables included age, body mass index, previous surgery, gestational age, urgency of cesarean delivery, anesthesia type, surgeon's seniority, layers closed, and performance of tubal ligation.

Results: Mean (standard deviation) operative times for first (n=857), second (n=353), third (n=108) and fourth or more (n=30) cesarean deliveries were 56 (19), 60 (19), 69 (28) and 82 (31) minutes, respectively (P <0.0001, all groups different). Emergency status of the case and later gestational age were associated with shorter operative times. Higher body mass index, a less senior surgeon, the number of layers closed, and tubal ligation, increased operative times. These factors accounted for 18% of the variability.

Conclusions: Third and fourth cesarean delivery or the presence of other factors that could increase operative time may warrant catheter-based anesthetic techniques or the addition of adjunctive medications to prolong spinal anesthetic block. Institutional and individual surgeon factors may play an even more important role in determining surgical time.

Keywords: Cesarean delivery; Neuraxial anesthesia; Operative time.

Fig. 1

CD: cesarean delivery. Mean cesarean delivery times (total operative times) and skin to uterine incision (± standard deviation) in minutes. N = number of cases per group. ANOVA demonstrated difference among groups (P <0.0001) and post hoc test (Scheffe) confirmed that all total operative times were different (C1 versus C2, P=0.03; C1 versus C3, P <0.001, C1 versus C4, P <0.001, C2 versus C4, P <0.0001, C3 versus C4, P=0.034)*. ANOVA demonstrated difference among all groups (P <0.0001) and post hoc test (Scheffe) confirmed that all groups were different for skin to uterine incision times (C1 versus C2, P=0.000, C1 versus C3, P=0.000, C2 versus C3, P=0.05, C2 versus C4, P=0.002)

Fig. 2

Decision algorithm for type of anesthesia. CD: cesarean delivery; ~: approximately; BMI: body mass index; BTL: bilateral tubal ligation; PGY: postgraduate year. Algorithm created as an aid in a decision-making process that takes into account institutional operative times and factors influencing those times.