# A Hospital-Based Quality Improvement Initiative to Reduce Postdural Puncture Headache in Cesarean Deliveries

## TL;DR

A hospital improved cesarean delivery outcomes by reducing postdural puncture headaches through better operating room efficiency and anesthetic practices.

## Contribution

A scalable quality improvement model using PDSA cycles to reduce PDPH in cesarean deliveries.

## Key findings

- PDPH incidence dropped from 16% to 1.5% after interventions.
- Operating room time decreased by 20 minutes on average.
- Vasopressor use and hemodynamic instability were significantly reduced.

## Abstract

Background: Postdural puncture headache (PDPH) is a major complication of neuraxial anesthesia in cesarean deliveries. This study aimed to reduce PDPH incidence through a quality improvement initiative focusing on operating room (OR) efficiency and anesthetic management.

Methods: Using Plan-Do-Study-Act (PDSA) cycles, interventions included preoperative catheterization, synchronized scrubbing, and improved surgeon-anesthetist coordination. Spinal anesthesia protocols were refined with atraumatic needle techniques and standardized vasopressor use. Data from the pre-intervention (April to October 2023) and post-intervention (November 2023 to April 2024) periods were compared.

Results: OR time decreased from 105 to 85 minutes. PDPH incidence dropped from 16% (21/140 lower segment cesarean sections (LSCS)) to 1.5% (2/127 LSCS). Vasopressor use declined, with ephedrine doses reducing from 17 mg to 6 mg and phenylephrine from 30 mcg to 5 mcg, improving hemodynamic stability.

Conclusion: Workflow enhancements effectively reduced PDPH incidence by optimizing OR efficiency and anesthetic management. Iterative PDSA cycles and real-time feedback contributed to sustained improvements, offering a scalable model for cesarean delivery quality improvement.