Journal article
Blood pressure during induction of anesthesia for cesarean delivery fails as a quality measure for comparison of anesthesiologists’ performance
Perioperative care and operating room management, Vol.45(December 2026), 100749
09/28/2026
DOI: 10.1016/j.pcorm.2026.100749
Abstract
During cesarean delivery, maternal hypotension is a common and important complication of anesthetic management. We assessed whether the minimum systolic blood pressure (SBP) from anesthesia induction to delivery, expressed as a ratio of baseline SBP, is a reliable metric for peer comparison.
The retrospective cohort had 10,125 cesarean deliveries performed between January 2012 and March 2026, of which 9,792 had one of the 133 anesthesiologists documented at the time of induction (e.g., spinal dosing). The baseline SBP was defined as the most recent SBP recorded before induction. Mixed-effects intercept-only regression was used to quantify the systemic variability in the SBP ratio among anesthesiologists. The intraclass correlation coefficient was used to quantify whether clinically meaningful variability existed among anesthesiologists relative to overall patient-level variability.
The minimum SBP ratio was < 0.90 for 63.2% of cases. The grand mean for the minimum SBP ratio was 0.852. Empirical Bayes estimates were significantly below 0.90 for 111 of the 133 anesthesiologists. However, variability among anesthesiologists was small, with intraclass correlation coefficient of only 0.018. The estimate was precise, with a narrow confidence interval, 0.9% to 3.5%.
Anesthesiologist-level differences accounted for only a small fraction of the variability in minimum SBP ratio, making its between-clinician variability an unreliable metric for comparing anesthesiologist performance.
Details
- Title: Subtitle
- Blood pressure during induction of anesthesia for cesarean delivery fails as a quality measure for comparison of anesthesiologists’ performance
- Creators
- Franklin Dexter - University of IowaUnyime S. Ituk - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Perioperative care and operating room management, Vol.45(December 2026), 100749
- DOI
- 10.1016/j.pcorm.2026.100749
- ISSN
- 2405-6030
- eISSN
- 2405-6030
- Publisher
- Elsevier Inc
- Language
- English
- Date published
- 09/28/2026
- Academic Unit
- Anesthesia
- Record Identifier
- 9985236349402771
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