A Scoping Review on the Incidence of Nonoperating Room Anesthesia Safety Events

To determine the incidence of adverse and near-miss events in nonoperating room anesthesia (NORA); to identify study methodology, strength of findings, and knowledge gaps regarding these events.

A scoping review was performed between 2022 and 2023, surveying literature from 2006 to 2023. The included studies examined adults undergoing a NORA procedure. Excluded studies were in the intensive care unit, peripartum areas, the operating room, or pediatric only.

A total of 586 records were identified using the keywords: "NORA," "non-operating room anesthesia," "anesthesia," "adverse event," and "near miss event." After screening, 58 full texts were reviewed and 12 studies were included. Five were retrospective observational, 4 were retrospective claims analyses, and 3 were surveys. Incidence rates of adverse events ranged from 0.01% to 38.6%, partially reflecting heterogeneity in event definition. Only one publication studied near-miss events: a retrospective survey of anesthesia providers. It described that near-miss events occurred more often but were reported less frequently than adverse events. A near-miss incidence rate could not be determined. Included articles were assessed using the Grading of Recommendations, Assessment, Development, and Evaluations System criteria. The overall quality was low to moderate.

There is limited investigation regarding NORA safety events and a lack of high-quality prospective studies. Specific areas for future investigation include: (1) standardized definition and incidence of safety events; (2) specific study of near-miss events; (3) evidence-based recommendations to optimize safety. Considering the anticipated growth of procedures and heterogenous locations, our findings strongly suggest a dedicated study of NORA-specific safety concerns.