PL.16 Does the Use of Carbetocin Reduce Recovery Times at Caesarean Section? An Audit of Outcomes Following Routine Introduction of Carbetocin at Southmead Hospital

Abstract

Objectives (i) Demonstrate a reduction in recovery time amongst women who received carbetocin at caesarean section (CS) compared with a historical cohort (ii) Establish whether RCT findings are consistent with real world clinical practice within a busy obstetric department. RCT data suggest a reduction in the need for further oxytocic agents in those women who receive carbetocin rather than oxytocin. Methods This is a cross-sectional pragmatic study with an interventional group. We evaluated outcomes for all women (elective and emergency) undergoing CS, after the introduction of carbetocin in April 2012. The controls comprised every 3rd patient undergoing CS in January 2012 (pre-carbetocin) and a contemporaneous cohort of women undergoing CS during August 2012 when carbetocin was not in stock. The data were not normally distributed; median values and Mann-Whitney U-Test were used. Some incomplete carbetocin proforma were returned due to prospective completion. The main outcome measure was theatre recovery time for use of carbetocin or syntocinon for routine 3rd stage management. Secondary outcome measures were: blood loss and requirement for additional uterotonic drugs (including syntocinon infusion and haemabate). Results Total proformas: carbetocin n = 264 syntocinon n = 130. Theatre recovery time (Prolonged HDU care on delivery suite were excluded: carbetocin, n = 11, syntocinon, n = 13 incomplete forms: carbetocin, n = 39, syntocinon, n = 0). There was no difference in blood loss between the groups; median 500 mL. Carbetocin use is significantly less likely to need additional uterotonic drugs: carbetocin 15.3%, syntocinon 40.5%, P = 0.0001. Conclusions Carbetocin decreases time spent in recovery post-CS (median-25 min per patient). There is a significant reduction in recovery duration >3 or >4 hours, which may have an impact on theatre efficiency. Carbetocin reduces the need for additional 3rd stage management. Using financial modeling the drug cost per patient, when all third stage requirements are included, is carbetocin 8.16 vs. syntocinon 7.93. In addition, 25 minutes reduced theatre recovery time has potential midwifery staffing cost efficiencies of up to 47 250 per annum.