Statewide Analysis of Anesthesia-Related Complications in Labor and Delivery: North Carolina, 2015-2020

We aimed to evaluate the incidence, hospital resource utilization, and risk factors associated with anesthesia-related complications during labor and delivery in North Carolina.

Using data from the 2015-2020 State Inpatient Database, we conducted a retrospective cross-sectional analysis of a representative sample of hospital deliveries involving anesthesia-related complications. The State Inpatient Database is a collection of databases and software tools created for the Healthcare Cost and Utilization Project, which compiles inpatient discharge records from community hospitals across selected states. A combination of International Classification of Diseases, 10th Revision, Clinical Modification codes, International Classification of Diseases,10th Revision, Procedure Coding System codes, and Diagnosis Related Groups was used to extract variables. Descriptive statistics, proportions, and incidence rates of anesthesia-related complications were calculated. Simple and multivariable logistic regression models were used to identify factors associated with an increased likelihood of anesthesia-related complications. A stepwise regression approach was used to fit the model. The calibration of the model was assessed using the deviance-Pearson goodness-of-fit statistics. To assess the cost associated with anesthesia-related complications, we compared the mean length of stay and total hospital charges between deliveries with and without anesthesia-related complications.

Among 592,868 hospital deliveries in North Carolina between 2015 and 2020, anesthesia-related complications were identified in 1735 cases, corresponding to an incidence rate of 2.9/1000 discharges (95% confidence interval 2.7-3.0). Spinal cord complications were the most prevalent (73.9%), followed by adverse effects (20.2%) and systemic complications (5.9%). During the 6-year study period, spinal cord complications increased from 65% to 70%, systemic complications rose from 5% to 9%, and adverse effects decreased from 30% to 20%. The highest incidence rates (per 100 discharges) were observed among women aged 40 to 55 years, Hispanic and Asian/Pacific Islander individuals (0.31), those with nontraditional insurance payers (0.39), patients undergoing more than three hospital procedures (0.49), those with a length of stay exceeding 3 days (0.57), women from higher-income households (0.32), and those with a higher (≥1) Charlson Comorbidity Index (0.41). Approximately 30% of deliveries were performed via cesarean section, with 37% of these cases associated with anesthesia-related complications. In the adjusted multivariable regression analyses, a higher risk of anesthesia-related complications also was observed among cesarean section deliveries, admissions to rural hospitals, other payers, and patients with a Charlson Comorbidity Index of ≥1.

Although anesthesia-related complications during labor and delivery are relatively uncommon, they are linked to distinct demographic, clinical, and hospital-level risk factors. This analysis highlights key areas for quality improvement aimed at reducing complications, particularly among high-risk populations. Continued efforts to enhance maternal safety should focus on equitable access to provider resources, standardized clinical protocols, and robust monitoring strategies, both within North Carolina and more broadly.