Stemming the Tide of Obstetric Morbidity: An Opportunity for the Anesthesiologist to Embrace the Role of Peridelivery Physician.

Anesthesiology, V 123 • No 5 986 November 2015 A nesthesia and analgesia for childbirth have become remarkably safe and together account for fewer than one maternal death per million deliveries, representing a 75% decline from the corresponding rate in 1980.1,2 although maternal deaths from anesthesia are rare, anesthesiarelated complications persist. Based on data from 30 north american institutions over a 5-yr period, approximately 1 in 3,000 anesthetics for delivery results in a serious complication of anesthesia, most commonly high neuraxial blockade or difficult intubation.3 Dural puncture, considered separately, complicated 0.7% of all neuraxial anesthetics. as with many adverse maternal outcomes, the event rates of anesthesia complications are both sufficiently rare that they are difficult to study at the clinical level and unacceptably high from a societal perspective. While important, few population-level data are available to identify temporal trends in the complication frequency of anesthesia administered specifically for cesarean delivery. The study in this month’s anesthesiology by guglielminotti et al.4 attempts to fill this gap. The investigators used administrative data from the state of new york between 2003 and 2012 to analyze adverse outcomes over time. overall, anesthesia-related complications declined 25% over the duration of the study. secondary analyses investigated trends stratified by anesthetic technique and suggest a 25% decrease in risk of anesthesia-related adverse events among women receiving neuraxial anesthesia without a general anesthetic and a 21% decrease in the use of general anesthesia. administrative data collected primarily for the reimbursement for healthcare services facilitates analysis of rare but important events because this kind of data includes diagnosis and procedure codes from the international Classification of Diseases. administrative data have been an important tool in studies of the epidemiology of pregnancy-related complications and are used by the U.s. Centers for Disease Control and Prevention as the primary national surveillance tool for maternal morbidity.5,6 anesthesia complications identified in administrative data have been proposed as a quality measure, and outlier hospitals have been identified.7,8 however, studying anesthesia complications with administrative data presents particular challenges. Diagnosis codes for anesthesia complications do not align directly with clinically meaningful complications. Close to 40% of analyzed events in the current study received an International Classification of Diseases, ninth Revision, Clinical Modification code for “other and unspecified systemic adverse events,” which could indicate a wide range of complication types, from the trivial to the Stemming the Tide of Obstetric Morbidity