Factors influencing cesarean delivery operative times: a prospective observational cohort study

This study aimed to determine the distribution of operative delivery times for uncomplicated parturients undergoing elective cesarean delivery with neuraxial anesthesia. A secondary aim was to explore patient and surgical factors associated with longer cesarean delivery times.

A prospective observational study of 331 parturients undergoing elective cesarean delivery with neuraxial anesthesia was conducted. Factors examined included age, body mass index, ethnicity, number of previous cesarean deliveries, stretch mark and scar severity and surgical experience.

Operative times ranged from 13 to 108 min with a mean (SD) of 43.4 (±15.7) min. Only 6 (1.8%) parturients had operative times >90 min and none were converted to general anesthesia. As the number of previous cesarean deliveries increased, the mean operative time increased linearly from 39.5 (±13.0) min in subjects with no previous cesarean deliveries to 52.8 (±18.1) min in subjects with 3 or 4 previous cesarean deliveries (P<0.0005). For parturients with previous cesarean deliveries, operative times were longer for those with scar scores > or =5 than for those with scores <5 (P<0.01). Stretch mark scores were not associated with operative times. Tubal ligation prolonged the total operative time by a mean of 7 min (P<0.0005), and attending staff required a mean of 6 more min than residents or fellows (P<0.01). There was no correlation between operative times, age and body mass index and little variation with ethnicity.

These findings identify previous cesarean deliveries, increased scar intensity, tubal ligation and surgical experience as factors that increase operative times for cesarean delivery. The data also suggest that neuraxial anesthesia lasting 90 min should provide adequate analgesia for most uncomplicated parturients undergoing elective cesarean delivery.