Changes in the choice of anaesthetic techniques for caesarean sections among Turkish citizens and migrants during the COVID-19 pandemic: an interrupted time series analysis.

Abstract

Background: The aim of the study was to examine the impact of the COVID-19 pandemic on changes in the choice of anaesthetic techniques for singleton caesarean sections among Turkish citizens and migrants before, during the first year of the COVID-19 pandemic, and after vaccination.

Methods: This single-center, retrospective observational study was conducted at a tertiary care hospital in Istanbul, Turkey. It included data from 9,744 consecutive women-7,083 (72.7%) Turkish citizens and 2,661 (27.3%) migrants-who underwent singleton caesarean sections between March 2018 and March 2023. The primary outcome was the change in monthly utilization rates of neuraxial anaesthesia (NA) during the COVID-19 pandemic. Secondary objectives included caesarean section urgency and neonatal outcomes.

Results: During the study period, there was an increasing trend in the number of caesarean sections performed using NA among Turkish citizens and migrants (relative ratio [RR] 1.003, P < 0.001 and RR 1.005, P < 0.01, respectively). Both groups showed a significant immediate increase in the usage rate of NA at the onset of the COVID-19 pandemic (RR 1.095, P < 0.001 and 1.134, P < 0.001, respectively). The introduction of vaccination had no effect on the use of NA (RR 0.970, P = 1.004, and RR 1.000, P = 0.99, respectively). The significant between-group difference in the pre-pandemic usage rate of NA diminished following the onset of the COVID-19 pandemic, with no significant between-group difference observed after vaccination (93.3% vs. 90.9%., P = 0.006, 98.4% vs. 97.1%, P = 0.0; 95.4% vs. 95.2%, P = 0.801, respectively). Category-1 caesarean section events increased throughout the study period (471(10.7%) before COVID-19, 321(17.0%) during the first year, and 700 (20.2%) after vaccination; P < 0.001). There were no significant differences in the incidence of composite adverse neonatal outcomes (stillbirths, Apgar 5-min score < 7) among the three time periods (89(2.0%), 41(2.2%), and 49(1.4%); P = 0.065).

Conclusion: During the COVID-19 pandemic, our study revealed a continuation of the upward trend in the use of NA for caesarean sections.