{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T20:17:56Z","timestamp":1779394676486,"version":"3.53.1"},"reference-count":40,"publisher":"Oxford University Press (OUP)","funder":[{"name":"Uniformed Services University through Henry M. Jackson Foundation"},{"name":"Advancement of Military Medicine, Inc.","award":["#HU00011920042"],"award-info":[{"award-number":["#HU00011920042"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Clinical practice guidelines indicate general anesthesia should be avoided for cesarean deliveries, when possible. In the U.S. Military Health System, understanding multifaceted predictors of general anesthesia for cesarean deliveries can be used to enhance value-based obstetric care efforts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>This retrospective observational cohort study included adult patients who experienced a cesarean delivery in a military treatment facility between January 2018 and October 2024. Potential covariates included patient characteristics, diagnoses, and pregnancy care information. Pre-delivery general anesthesia receipt was evaluated using a generalized additive mixed model with a random effect for facility. Sensitivity analyses repeated the model with (a) a sample restricted to patients with gestation ages &amp;gt;35 weeks and (b) a multinomial outcome comparing neuraxial only to general only and neuraxial-to-general conversion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of patients with available anesthesia information (N\u2009=\u200915,181), the general anesthesia rate was 4.8%. After applying additional exclusion criteria for the primary analysis, the rate was 4.4% in the final sample (N\u2009=\u200911,921); of whom, 51% had also received neuraxial anesthesia. There were 34 unique facilities represented in the data. In the primary model, the odds of general anesthesia receipt was higher for Black compared to White patients (OR 1.31, 95% CI, 1.01-1.69, P\u2009=\u2009.04), those who were not military-connected compared to military-connected (OR 1.29, 95% CI, 1.05-1.60, P\u2009=\u2009.02), patients with fetal abnormalities and stress diagnoses compared to those without (OR 2.61, 95% CI, 2.15-3.16, P\u2009&amp;lt;\u2009.001), those with umbilical cord complications diagnoses compared to those without (OR 1.30, 95% CI, 1.04-1.64, P\u2009=\u2009.02), and patients with other labor and delivery complications diagnoses compared to those without (OR 1.74, 95% CI, 1.38-2.19, P\u2009&amp;lt;\u2009.001). General anesthesia odds were lower for patients whose health plan sponsors were senior enlisted service members (OR 0.73, 95% CI, 0.59-0.91, P\u2009=\u2009.01) and officers (OR 0.73, 95% CI, 0.53-0.999, P\u2009=\u2009.049) compared to junior enlisted service members, as well as patients who received care justifying non-elective delivery compared to those who did not (OR 0.62, 95% CI, 0.50-0.78, P\u2009&amp;lt;\u2009.001). Lastly, there were significant, nonlinear relationships between gestational age (P\u2009&amp;lt;\u2009.001) and direct care percent (P\u2009=\u2009.01) with general anesthesia receipt. The estimated probability (95% CI) of general anesthesia was highest at 30 weeks\u2019 gestation (17%, 11%-23%), which decreased through 41 weeks\u2019 gestation (4%, 3%-6%), before increasing slightly at 42 weeks (5%, 3%-7%). As direct care percent increased, the probability of general anesthesia decreased, for example patients receiving 25% (8%, 5%-10%) and 50% (6%, 5%-7%) of pre-delivery care in the direct care system had higher probabilities than those receiving 75% (5%, 4%-5%) and 100% (4%, 4%-5%). Lastly, there was a significant random effect for facilities, indicating probabilities were different across delivery locations (P\u2009=\u2009.003). Sensitivity models had similar findings, with nuanced differences in the multinomial model across general anesthesia groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The present findings could be used to value-based obstetric care efforts around regional anesthesia and cesarean delivery outcomes in the U.S. Military Health System.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/milmed\/usag228","type":"journal-article","created":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T12:28:06Z","timestamp":1777638486000},"source":"Crossref","is-referenced-by-count":0,"title":["Predictors of General Anesthesia Receipt During Cesarean Deliveries in the U.S. Military Health System: A Retrospective Cohort Study"],"prefix":"10.1093","author":[{"given":"Brianna","family":"Johnson","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Madigan Army Medical Center , Joint Base Lewis-McChord, WA 98431,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin C","family":"Cordova","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Walter Reed National Military Medical Center , Bethesda, MD 20889,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander G","family":"Velosky","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Uniformed Services University Defense and Veterans Center for Integrative Pain Management, , Bethesda, MD 20814,","place":["United States"]},{"name":"Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. , Bethesda, MD 20817,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kendra D","family":"Outler","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Management, J. H. Stroger Hospital of Cook County , Chicago, IL 60612,","place":["United States"]},{"name":"Department of Anesthesiology, Uniformed Services University , Bethesda, MD 20814,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3815-2571","authenticated-orcid":false,"given":"Krista B","family":"Highland","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Uniformed Services University , Bethesda, MD 20814,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,5,21]]},"reference":[{"key":"2026052115513609700_usag228-B1","author":"Committee on Obstetric Anesthesia","year":"2024"},{"key":"2026052115513609700_usag228-B2","author":"Committee on Obstetric Anesthesia","year":"2023"},{"key":"2026052115513609700_usag228-B3","doi-asserted-by":"publisher","first-page":"912","DOI":"10.1097\/ALN.0000000000002629","article-title":"Adverse events and factors associated with potentially avoidable use of general anesthesia in cesarean deliveries","volume":"130","author":"Guglielminotti","year":"2019","journal-title":"Anesthesiology"},{"key":"2026052115513609700_usag228-B4","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1097\/ALN.0000000000005785","article-title":"Neonatal outcomes with regional versus general anesthesia for cesarean delivery: a meta-analysis of randomized controlled trials","volume":"144","author":"Langer","year":"2026","journal-title":"Anesthesiology"},{"key":"2026052115513609700_usag228-B5","doi-asserted-by":"publisher","first-page":"e2350825","DOI":"10.1001\/jamanetworkopen.2023.50825","article-title":"Racial and ethnic disparities in receipt of general anesthesia for cesarean delivery","volume":"7","author":"Thomas","year":"2024","journal-title":"JAMA Netw Open"},{"key":"2026052115513609700_usag228-B6","doi-asserted-by":"publisher","first-page":"e19729","DOI":"10.7759\/cureus.19729","article-title":"An update on racial and ethnic differences in neuraxial anesthesia for cesarean delivery","volume":"13","author":"Burton","year":"2021","journal-title":"Cureus"},{"key":"2026052115513609700_usag228-B7","doi-asserted-by":"publisher","first-page":"472","DOI":"10.1213\/ANE.0000000000000679","article-title":"Racial and ethnic disparities in mode of anesthesia for cesarean delivery","volume":"122","author":"Butwick","year":"2016","journal-title":"Anesth Analg"},{"key":"2026052115513609700_usag228-B8","doi-asserted-by":"publisher","first-page":"109821","DOI":"10.1016\/j.jclinane.2020.109821","article-title":"Racial and ethnic disparities in severe maternal morbidity and anesthetic techniques for obstetric deliveries: a multi-state analysis, 2007-2014","volume":"65","author":"Tangel","year":"2020","journal-title":"J Clin Anesth"},{"key":"2026052115513609700_usag228-B9","doi-asserted-by":"publisher","first-page":"514","DOI":"10.1186\/s12884-023-05818-9","article-title":"The association between hypertensive disorders during pregnancy and maternal and neonatal outcomes: a retrospective claims analysis","volume":"23","author":"Bromfield","year":"2023","journal-title":"BMC Pregnancy Childbirth"},{"key":"2026052115513609700_usag228-B10","doi-asserted-by":"publisher","first-page":"100491","DOI":"10.1016\/j.ajogmf.2021.100491","article-title":"Pregnancy outcomes in very advanced maternal age women","volume":"4","author":"Smithson","year":"2022","journal-title":"Am J Obstet Gynecol MFM"},{"key":"2026052115513609700_usag228-B11","doi-asserted-by":"publisher","first-page":"e2137716","DOI":"10.1001\/jamanetworkopen.2021.37716","article-title":"Comparison of delivery-related, early and late postpartum severe maternal morbidity among individuals with commercial insurance in the US, 2016 to 2017","volume":"4","author":"Admon","year":"2021","journal-title":"JAMA Netw Open"},{"key":"2026052115513609700_usag228-B12","volume-title":"Maternal Mortality Rates in the United States, 2023. 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