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Anesthesia practice for Cesarean delivery in Japan: a retrospective cohort study

Pratique de l’anesthésie pour les accouchements par césarienne au Japon : une étude de cohorte rétrospective

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Abstract

Purpose

General anesthesia for Cesarean delivery affects maternal and neonatal outcomes. We aimed to evaluate temporal trends in anesthesia management for Cesarean deliveries over 16 years and analyze interinstitutional variations in general anesthesia use in Japan.

Methods

In this retrospective cohort study, we obtained patient data from the nationwide health insurance claims database containing data for ten million individuals. We included patients who underwent Cesarean delivery between 1 January 2005 and 31 August 2021. The primary outcome was the use of general anesthesia. We evaluated institutional variations in general anesthesia use in medical facilities using two-level hierarchical logistic regression analyses with median odds ratios and intraclass correlation coefficients.

Results

The cohort included 86,793 patients who underwent 102,617 Cesarean deliveries at 2,496 institutions. General anesthesia was used in 3.7% (95% confidence interval [CI], 3.6 to 3.9) of all Cesarean deliveries. The temporal trend in the use of general anesthesia decreased gradually from 10.8% in 2005 to 2.9% in 2021 (P for trend < 0.001). The adjusted median odds ratio for medical facilities was 6.1 (95% CI, 5.9 to 6.7), and the intraclass correlation coefficient was 0.52 (95% CI, 0.51 to 0.55).

Conclusion

Although the rate of general anesthesia use for Cesarean delivery in Japan decreased gradually from 2005 to 2021, general anesthesia was used in 3.7% of all Cesarean deliveries. The use of general anesthesia varied significantly across institutions, and 52% of the overall variations in general anesthesia practice can be explained by differences between facilities.

Résumé

Objectif

L’anesthésie générale pour l’accouchement par césarienne affecte les issues maternelles et néonatales. Notre objectif était d’évaluer les tendances temporelles de la prise en charge anesthésique pour les accouchements par césarienne sur 16 ans et d’analyser les variations interinstitutionnelles dans l’utilisation de l’anesthésie générale au Japon.

Méthode

Dans cette étude de cohorte rétrospective, nous avons obtenu des données sur les patient·es à partir de la base de données nationale des réclamations d’assurance maladie contenant des données pour dix millions de personnes. Nous avons inclus les personnes ayant bénéficié d’un accouchement par césarienne entre le 1er janvier 2005 et le 31 août 2021. Le critère d’évaluation principal était le taux d’utilisation de l’anesthésie générale. Nous avons évalué les variations institutionnelles dans l’utilisation de l’anesthésie générale dans les établissements médicaux à l’aide d’analyses de régression logistique hiérarchique à deux niveaux avec des rapports de cotes médians et des coefficients de corrélation intraclasse.

Résultats

La cohorte comprenait 86 793 patient·es ayant bénéficié de 102 617 accouchements par césarienne dans 2496 établissements. L’anesthésie générale a été utilisée dans 3,7 % (intervalle de confiance [IC] à 95 %, 3,6 à 3,9) de tous les accouchements par césarienne. La tendance temporelle de l’utilisation de l’anesthésie générale a diminué graduellement, passant de 10,8 % en 2005 à 2,9 % en 2021 (P pour la tendance < 0,001). Le rapport de cotes médian ajusté pour les établissements médicaux était de 6,1 (IC 95 %, 5,9 à 6,7), et le coefficient de corrélation intraclasse était de 0,52 (IC 95 %, 0,51 à 0,55).

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Author contributions

Hiroshi Yonekura conceived and designed the study, analyzed the data, and wrote the manuscript. Yusuke Mazda and Shohei Noguchi contributed to the study design, data interpretation, and manuscript drafting. Hironaka Tsunobuchi and Koji Kawakami wrote and critically revised the manuscript.

Acknowledgements

This work was supported by JSPS KAKENHI (grant number: JP20K17834) and the Research Institute of Healthcare Data Science. The authors thank the staff at JMDC Co., Ltd, Tokyo, Japan, for assistance with data preparation. The authors also thank Editage (www.editage.jp) for English language editing.

Disclosures

Koji Kawakami received advisory fees from Shin Nippon Biomedical Laboratories, Ltd., Japan, JMDC Inc., Japan, LEBER Inc., and CICS, Japan; research funds from Eisai, Kyowa Kirin, and Real World Data, Co, Ltd, Japan; and held stock of Real World Data, Co., Ltd, Japan. Other authors have no direct or indirect conflicts of interest.

Funding statement

This study was funded by the Japan Society for the Promotion of Science and Grants-in-Aid for Scientific Research (grant number JP20K17834) and the Research Institute of Healthcare Data Science.

Prior conference presentations

This study was presented in part at the 69th Annual meeting of the Japanese Society of Anesthesiologists (16–18 June 2022, Kobe, Hyogo, Japan).

Data availability

Data are not publicly available. The data sets analyzed in this study are available from the corresponding author (HY) upon reasonable request.

Editorial responsibility

This submission was handled by Dr. Philip M. Jones, Deputy Editor-in-Chief, Canadian Journal of Anesthesia/Journal canadien d’anesthésie.

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Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, Fujita Health University Bantane Hospital, 3-6-10 Otoubashi, Nakagawa-Ku, Nagoya City, Aichi, 454-8509, Japan

    Hiroshi Yonekura MD, MPH, PhD

  2. Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan

    Hiroshi Yonekura MD, MPH, PhD & Koji Kawakami MD, PhD

  3. Department of Obstetric Anesthesiology, Center for Maternal-Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan

    Yusuke Mazda MD, PhD & Shohei Noguchi MD, PhD

  4. Department of Anesthesiology and Pain Medicine, Fujita Health University Bantane Hospital, Aichi, Japan

    Hironaka Tsunobuchi MD, PhD

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  1. Hiroshi Yonekura MD, MPH, PhD
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  3. Shohei Noguchi MD, PhD
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Correspondence to Hiroshi Yonekura MD, MPH, PhD.

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Yonekura, H., Mazda, Y., Noguchi, S. et al. Anesthesia practice for Cesarean delivery in Japan: a retrospective cohort study. Can J Anesth/J Can Anesth 71, 175–186 (2024). https://doi.org/10.1007/s12630-023-02633-w

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