Variability in risk tolerance and adherence to guidelines in “go or no‐go” decisions among anesthetists handling obstetric patients in Saudi Arabia

Background: Decision-making in obstetric anesthesia is critical for patient safety. Yet, adherence to clinical guidelines varies among anesthetists. Previous research has shown significant variability in risk tolerance when making “go or no-go” decisions. Still, limited data exist on how these decisions are influenced by experience and training in obstetric cases. This study aims to assess the variability in risk tolerance and adherence to guidelines among anesthetists providing care to obstetric patients in Saudi Arabia and identify factors influencing their decisions. Methods: A cross-sectional, questionnaire-based study was conducted among 188 anesthetists practicing in Saudi Arabia. The survey included 10 clinical scenarios requiring anesthetists to decide whether to proceed with anesthesia under suboptimal conditions. Responses were analyzed using a four-point Likert scale. Descriptive statistics and Chi-square tests were used to assess the association between decision-making and independent factors such as level of training, years of experience, and previous exposure to similar cases. Results: There was no absolute consensus in decision-making across the scenarios. The majority opted not to proceed in cases involving patient safety risks, such as absent cross-matching blood (82%) or a malfunctioning anesthesia machine (89%). Previous exposure to similar cases was the only significant factor influencing the anesthetists’ decisions ( P < 0.0001). Training level, experience, and training location had no significant impact. Conclusion: Variability in decision-making suggests that risk tolerance is not solely dependent on experience but is shaped by prior case exposure. Strengthening simulation-based training and structured risk assessment tools may improve adherence to clinical guidelines in obstetric anesthesia.