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Intraoperative reported adverse events in children
Athina Kakavouli1, Guohua Li, Margaret P Carson
1Department of Anesthesiology, Columbia University, New York, NY 10032, USA.
Insights
Pediatric anesthesia adverse events (AE) were similar in operating rooms (ORA) and outside operating rooms (NORA). Higher American Society of Anesthesiologists (ASA) status and younger age increased AE risk for children undergoing procedures.
Area of Science:
- Pediatric Anesthesiology
- Patient Safety
- Quality Assurance
Background:
- Significant intraprocedural adverse events (AE) are documented in pediatric anesthesia outside the operating room (NORA).
- Limited data exists comparing AE in NORA versus anesthesia within the operating room (ORA) when managed by a consistent anesthesia team.
Purpose of the Study:
- To elucidate incidences of intraoperative AE in children receiving anesthesia in NORA and ORA locations.
- To assess the association between patient risk factors and AE incidence based on procedure location, adjusting for American Society of Anesthesiologists (ASA) status, age, and procedure scheduling.
Main Methods:
- Utilized patient-specific Quality Assurance questionnaires (QAs) for data collection from May 2006 to September 2007.
- Analyzed data from 8707 pediatric cases (under 21 years) including service location, procedure type, age, ASA status, and AE presence/type.
- Employed multivariate logistic regression to identify risk factors for AE.
Main Results:
- Overall AE incidence was 3.5%, with 2.5% in NORA and 3.7% in ORA cases.
- Higher ASA status and younger age were significantly associated with increased AE risk, independent of procedure location or scheduling.
- Respiratory-related events were the most common AE (1.9%) in both NORA and ORA settings.
Conclusions:
- Pediatric AE incidence is comparable between NORA and ORA locations.
- Younger age and higher ASA status are key predictors of increased AE risk in pediatric anesthesia.
- Consistent anesthesia care teams may contribute to similar safety profiles across different procedural locations.
Background:
Significant intraprocedural adverse events (AE) are reported in children who receive anesthesia for procedures outside the Operating Rooms (NORA). No study, so far, has characterized AE in children who receive anesthesia in the operating rooms (ORA) and NORA when anesthesia care is provided by the same team in a consistent manner.
Objective/Aim:
We used the same patient-specific Quality Assurance questionnaires (QAs), to elucidate incidences of intraoperative reported AE for children receiving anesthesia in NORA and ORA locations. Through multivariate logistic regression analysis, we assessed the association between patient's AE risk and procedure's location while adjusting for American Society of Anesthesiologists (ASA) status, age, and unscheduled nature of the procedure.
Methods/Materials:
After Institutional Review Board approval, we used returned QAs of patients under 21 years, who received anesthesia from our pediatric anesthesia faculty from May 1 2006 through September 30, 2007. We analyzed QA data on: service location, unscheduled/scheduled procedure, age, ASA status, presence, and type of AE. We excluded QAs with incomplete information on date, location, age, and ASA status.
Results:
We included 8707 cases, with 3.5% incidence of reported AE. We had 1898 NORA and 6808 ORA cases with AE incidence of 2.5% and 3.7%, respectively. Multivariate regression analysis revealed that patients with higher ASA status or younger age had higher incidence of reported AE, irrespective of location or unscheduled nature of the procedure. The most common AE type, for both sites, was respiratory related (1.9%).
Conclusions:
Pediatric reported AE incidence was comparable for NORA and ORA locations. Younger age or higher ASA status are associated with increased risk of AE.
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