Influencing factors of general anesthesia and spinal anesthesia for cesarean section women with PAH.

Objective

To compare the clinical efficacy and safety of general anesthesia versus spinal anesthesia for cesarean section in parturients with pulmonary arterial hypertension (PAH), and analyze the influencing factors for postoperative adverse outcomes.

Methods

A retrospective cohort study was conducted on 236 PAH parturients who underwent cesarean section from January 2022 to December 2024. All subjects were grouped via propensity score matching into the general anesthesia group (Group A, n=104) and the spinal anesthesia group (Group B, n=132). Intraoperative hemodynamic parameters, surgical indicators, postoperative adverse events, and neonatal outcomes were compared between the two groups. Subgroup analysis, univariate and multivariate Logistic regression analyses, receiver operating characteristic (ROC) curve analysis, and forest plot analysis were performed for statistical evaluation.

Results

At time points T1 to T3, Group B presented significantly lower mean arterial pressure and heart rate with milder hemodynamic fluctuations, less intraoperative blood loss, and a lower overall incidence of adverse events than Group A (all P<0.05). In subgroups of severe PAH and New York Heart Association (NYHA) class III-IV cardiac function, Group B also showed a reduced adverse event rate (P<0.05). Multivariate Logistic regression analysis identified preoperative NYHA classification, anesthesia modality, PAH severity, and preoperative hemoglobin level as independent influencing factors for postoperative adverse outcomes (all P<0.05). ROC curve analysis demonstrated that the combined detection of the above three core indicators yielded superior predictive efficacy compared with single-index detection (P<0.05). The ROC curve of the validation group had an area under the curve (AUC) of 0.739, indicating favorable predictive performance of the model. The calibration curve verified excellent calibration capability, with predicted values highly consistent with actual clinical outcomes. The decision curve analysis showed that the nomogram model maintained positive net clinical benefits within a probability threshold range of 10-90%.

Conclusion

Spinal anesthesia provides safer and more stable perioperative hemodynamic conditions for PAH parturients undergoing cesarean section. The combined evaluation of preoperative clinical indicators can effectively predict postoperative adverse outcomes in this patient population.