The 7th National Audit Project activity survey: risk of understating obstetric anaesthesia workload

In their article reporting analysis of anaesthetic workload data collected as part of the 7th National Audit Project (NAP7), Kane et al. state that elective orthopaedic surgery was the largest by total anaesthetic activity workload, whereas their data shows that obstetric anaesthetic activity workload was the largest, when caesarean section and labour analgesia are combined as one speciality [1]. In addition, there is no reference to other obstetric procedures requiring anaesthesia such as assisted vaginal births, removal of placenta or repair of perineal tears. It seems odd to single out one procedure – caesarean section – as the sole indicator of obstetric operating theatre activity, when elective orthopaedic and general surgery groupings will include many different procedures. It should also be noted that all obstetric anaesthetic operating theatre activity will occur in one or maybe two theatres within a hospital, whilst orthopaedic, general surgery or other surgical specialities will be spread amongst several theatres with several different teams [2]. To judge the intensity of anaesthetic workload an appropriate denominator for activity would be the number of operating theatres and the number of anaesthetists available for each speciality. The NAP7 survey will not capture other activity, which for obstetric anaesthetists will include patient assessments in clinics and on the wards. The authors are correct to highlight that large-scale data about national anaesthetic practice are sparse, and any such available data relies on intermittent national audit projects by the Royal College of Anaesthetists. This is because anaesthetic activity in the NHS is not routinely coded by hospitals nor routinely collected in national datasets, an unfortunate deficit which hinders quality improvement in anaesthesia, the largest hospital speciality [3].