Pediatric perioperative adverse events requiring rapid response: a retrospective case-control study
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Published on: April 7, 2023
Laura E Schleelein1, Ariel M Vincent1, Abbas F Jawad1
1Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Insights
Pediatric perioperative adverse events, termed Anesthesia Now (AN!) events, occurred in 1 in 234 cases, primarily respiratory. Younger age and more complex cases increased AN! event risk.
Area of Science:
- Pediatric Anesthesiology
- Healthcare Quality Improvement
- Patient Safety
Background:
- Studying pediatric perioperative adverse events is difficult due to inconsistent definitions and data capture.
- Anesthesia Now (AN!) events are defined as perioperative adverse events requiring rapid response at CHOP.
- Cardiac cases are excluded from AN! event data collection.
Purpose of the Study:
- To determine the prevalence of perioperative adverse events (AN! events) at a pediatric quaternary-care center.
- To identify case characteristics associated with AN! events.
- To evaluate potential contributing factors to these events.
Main Methods:
- Retrospective case-control study of AN! events from April 2010 to September 2012.
- Data sourced from Compurecord, EPIC, and Chartmaxx systems.
- AN! events were matched 1:2 with non-cardiac control cases by surgical date.
Main Results:
- A total of 213 AN! events were documented, with a prevalence of 0.0043 (1:234).
- Respiratory events, mainly laryngospasm, were the most frequent.
- Younger median age (2.86 vs 6.20 years), higher ASA status, multiple surgical services, and operating room location were associated with increased AN! event risk.
Conclusions:
- Lower age, increased comorbidities, multiple surgical services, and operating room location are risk factors for AN! events.
- Decreased anesthesiologist experience was also linked to a higher risk of AN! events.
- Events were predominantly respiratory in nature.
Background:
Perioperative pediatric adverse events have been challenging to study within and across institutions due to varying definitions, low event rates, and incomplete capture.
Aim:
The aim of this study was to determine perioperative adverse event prevalence and to evaluate associated case characteristics and potential contributing factors at an academic pediatric quaternary-care center.
Methods:
At the Children's Hospital of Philadelphia (CHOP), perioperative adverse events requiring rapid response assistance are termed Anesthesia Now (AN!) events. They have been accurately captured and entered into a quality improvement database since 2010. Adverse events involving open heart and cardiac catheterization cases are managed separately and not included in this database. We conducted a retrospective case-control study utilizing Compurecord (Phillips Healthcare, Andover, MA, USA), EPIC (EPIC, Verona, WI, USA), and Chartmaxx (MedPlus, Mason, OH, USA) systems matching AN! event cases to noncardiac controls (1 : 2) based on surgical date.
Results:
From April 16, 2010 to September 25, 2012, we documented 213 AN! events in the noncardiac perioperative complex and remote sites at our main hospital. AN! prevalence was 0.0043 (1 : 234) with a 95% confidence interval (CI) (0.0037, 0.0049). Respiratory events, primarily laryngospasm, were most common followed by events of cardiovascular etiology. Median age was lower in the AN! group than in controls, 2.86 years (interquartile range 0.94, 10.1) vs 6.20 (2.85, 13.1), P < 0.0001. Odds ratios (with 95% CI) for age, 0.969 (0.941, 0.997); American Society of Anesthesiologists physical status, 1.67 (1.32, 2.12); multiple (≥2) services, 2.27 (1.13, 4.55); nonoperating room vs operating room location, 0.240 (0.133, 0.431); and attending anesthesiologist's experience, 0.976 (0.959, 0.992) were all significant.
Conclusions:
Decreased age, increased comorbidities, multiple (vs single) surgical services, operating room (vs nonoperating room) location, and decreased staff experience were associated with increased risk of AN! events, which were predominantly respiratory in origin.
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