Induction-to-delivery time and neonatal resuscitation after cesarean delivery under general anesthesia: a multicenter retrospective cohort study

General anesthesia (GA) remains an important option for cesarean delivery when neuraxial anesthesia is contraindicated or otherwise unsuitable, but it has been associated with less favorable neonatal outcomes. Among potential contributors, induction-to-delivery (ID) time—defined as the interval from the administration of general anesthetic agents to delivery of the neonate—may represent a clinically relevant perioperative factor. This study aimed to assess the relationship between ID time and the need for neonatal resuscitation during GA cesarean delivery, and to identify perioperative and maternal factors associated with increased resuscitation risk. A multicenter retrospective study was conducted among women with singleton pregnancies who underwent planned cesarean delivery under GA. Baseline maternal, anesthetic, and neonatal variables were collected. Categorical variables were analyzed using the Chi-square test, and continuous variables using the Wilcoxon rank-sum test. Univariable and multivariable logistic regression analyses were performed to identify factors independently associated with neonatal resuscitation, and a restricted cubic spline (RCS) model was used to evaluate the relationship between ID time and the probability of resuscitation. A total of 1,523 cases were included; 212 neonates (13.9%) required resuscitation. Prolonged ID time was independently associated with an increased likelihood of neonatal resuscitation (OR = 1.04 per minute; 95% CI 1.01–1.06, p = 0.003). Additional factors associated with neonatal resuscitation included gestational age < 34 weeks (OR = 17.11, 95% CI 10.49–28.17), gestational age 34–37 weeks (OR = 3.59, 95% CI 2.47–5.26), American Society of Anesthesiologists Physical Status III–IV (OR = 1.82, 95% CI 1.13–2.88), and anesthetic regimens involving propofol + sevoflurane (OR = 1.94, 95% CI 1.09–3.34) or other regimens (OR = 8.86, 95% CI 4.55–17.45) compared with propofol + remifentanil. The estimate for the small, heterogeneous ‘other regimens’ category should be interpreted cautiously. Exploratory RCS analysis showed an increasing probability of neonatal resuscitation with longer ID time. Longer ID time under GA was associated with a higher likelihood of neonatal resuscitation. ID time may serve as a clinically relevant perioperative marker in cesarean delivery under GA.