Evaluation of changes in anesthetic methods for cesarean delivery: an analysis for 5 years using the big data of the Korean Health Insurance Review and Assessment Service

Abstract

Background: As an anesthesia induced during cesarean section, spinal anesthesia is preferred over general and epidural anesthesia. This study aimed to review the trend of anesthetic methods for cesarean section based on data obtained from the Korean Health Insurance Review and Assessment Service from 2013 to 2018.

Methods: The anesthetic methods were analyzed in 753,285 parturients who underwent a cesarean section in Korea from 2013 to 2018. We determined the association between each anesthetic method and hospital type and maternal and fetal factors. We also evaluated whether the anesthetic method was associated with the parturients' length of hospital stay.

Results: General anesthesia, spinal anesthesia, and epidural anesthesia were induced in 28.8%, 47.7%, and 23.6% of parturients from 2013 to 2018, respectively. Trend analyses showed that spinal anesthesia increased from 40.0% in 2013 to 53.7% in 2018. The opposite trend applied to general anesthesia, decreasing from 37.1% in 2013 to 22.2% in 2018. The factors that were significantly associated with the anesthetic method were parturient's parity, emergency condition, gestational age, and fetal weight. The type of hospital, parturient's age, and multiple birth were also associated with the anesthetic methods. There was a strong association between general anesthesia and hospital stay longer than 7 days.

Conclusions: Spinal anesthesia is currently the main anesthetic method used for cesarean delivery, and the rate of spinal anesthesia is gradually increasing in Korea.

Keywords: Anesthesia, epidural; Anesthesia, general; Anesthesia, spinal; Cesarean section.

Fig. 1.

Flow diagram of parturients who underwent a cesarean section. *Korean Health Insurance Review and Assessment Service.

Fig. 2.

Trends in anesthetic methods of cesarean sections in the Korean Health Insurance Review and Assessment Service, 2013–2018. Values are expressed as percentages for each year. It shows a pattern of decrease in general anesthesia and an increase in spinal and epidural anesthesia over time (P < 0.001). Linear-by-linear association test was used for trend analysis.