Physical injuries during anaesthesia: A retrospective study during 6 years at a single institution

Physical injuries during anaesthesia, while seemingly minor compared to other complications, can cause significant patient suffering and medico-legal consequences. This study aimed to determine the incidence and risk factors of physical injuries during anaesthesia in a large tertiary hospital to identify areas for improvement in patient safety.

A retrospective analysis of prospectively collected data in a high-volume tertiary hospital performing 25,000 surgeries annually was conducted from 2014-2019. All physical injury incidents during anaesthesia were categorised into six groups: airway injuries, eye injuries, non-regional nerve injuries, regional nerve injuries, pressure injuries, and vascular injuries. Risk factors and outcomes were analysed using Chi-square tests, with P < 0.05 considered significant.

Among 161,645 anaesthetics, 246 physical injuries were reported (0.15% incidence). Pressure injuries were most common (36%), followed by airway injuries (35%), nerve injuries (14%), vascular injuries (12%), and eye injuries (3%). Physical injuries were twice as likely in patients with American Society of Anaesthesiologists Physical Status (ASA PS) ≥3 (0.28% vs 0.11%, P < 0.001) and four times more likely during after-hours procedures (0.53% vs 0.13%, P < 0.001). Overall, 60.3% required specialist review, 12.9% had temporary disabilities, and 0.73% had permanent disabilities. 31% of injuries were deemed preventable.

Physical injuries during anaesthesia occur in 15 per 10,000 cases, with higher ASA PS and after-hours procedures being significant risk factors. These findings support implementing enhanced protective protocols for high-risk patients and procedures to improve perioperative safety.