Incidence of general anaesthesia according to urgency of surgery: a multicentre prospective cohort study of 9989 Caesarean deliveries in Europe.

BACKGROUND

Contemporary data on anaesthesia for Caesarean delivery across Europe remain limited. We aimed to describe general anaesthesia (GA) use according to Caesarean delivery urgency in participating European countries.

METHODS

We performed a multicentre prospective cohort study including all Caesarean deliveries, without exclusion criteria, in 361 centres across 31 European countries from September 1, 2023 to April 30, 2025. Anaesthesiologists reported case details, including urgency category according to a four-category classification (emergency, urgent, expedited, elective). The primary outcome was anaesthesia technique.

RESULTS

A total of 9989 Caesarean deliveries were included. The overall GA incidence was 14.8% (n=1474; 95% confidence interval 14.0-15.5). According to urgency categories, GA incidences were 54.0% (n=384) for emergency cases, 13.8% (n=335) for urgent cases, 11.3% (n=252) for expedited cases, and 10.9% (n=503) for elective cases. GA was the initial anaesthesia technique for 7.6% of cases (n=759; 95% confidence interval 7.1-8.2). In elective cases, initial GA was most commonly owing to maternal request (47.0%; n=110), whereas, in emergency cases, emergent reasons (insufficient time for neuraxial anaesthesia) were the leading indication (58.4%; n=167). Conversion to GA occurred in 7.7% of 9228 initial neuraxial anaesthesia cases (n=715), most frequently in emergency cases (23.1%; n=98), but also in elective cases (6.1%; n=269).

CONCLUSIONS

This study provides a contemporary description of anaesthetic practice for Caesarean delivery in 31 participating countries in Europe. The GA incidence was five-fold higher for emergency than elective cases. However, our study cannot determine reasons for the differences or identify causal relationships.