Method of anaesthesia impact on total operating room time for second-trimester procedural abortion

Hospital-based second-trimester dilation and evacuation (D&E) procedures are often completed using general anaesthesia (GA) despite emerging evidence for the safety of monitored anaesthesia care (MAC). Limited data exist comparing these approaches for key clinical outcomes.

This retrospective cohort study compared those who received GA versus MAC during second-trimester (14-24 weeks' gestation) hospital-based D&Es. The primary outcome was total operating room (OR) time; secondary outcomes included surgical time, anaesthetic time, post anaesthesia care unit (PACU) time, estimated blood loss, and respiratory complications. We hypothesised that MAC would reduce the total OR time. We estimated that a sample size of 63 participants in each group would detect a 15-min or greater difference in total OR time with 80% power and a significance level of 0.05. Propensity score matching was used for sensitivity analysis.

During the study period, 125 patients received GA and 67 received MAC. Those receiving GA had significantly longer OR times (GA: 60.2±18.1 min vs MAC: 50.1±13.2 min, p=0.005) and greater estimated blood loss (GA: 150±286 mL vs MAC: 88±47 mL, p<0.001). No respiratory complications occurred in either group. A propensity score-matched analysis similarly found GA associated with longer OR time and higher blood loss.

MAC may offer additional clinical benefits compared with GA during hospital-based D&E care. MAC reduces OR time and blood loss without compromising safety, which may optimise patient care and resource use in abortion care settings.