What question did this study set out to answer?

To identify specific risk and protective factors in anesthesia management associated with 24-hour postoperative severe morbidity and mortality.

January 19, 2005AnesthesiologyOpen Access

Impact of Anesthesia Management Characteristics on Severe Morbidity and Mortality

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Why the study?

Do specific anesthesia management practices reduce the risk of 24-hour postoperative severe morbidity and mortality in patients undergoing anesthesia?

Population

869,483 patients undergoing anesthesia, from which 807 cases and 883 controls were analyzed.

Comparison

Specific anesthesia management practices vs Absence of these specific anesthesia management…

Design

Case-control

Follow-up

24 hours

Authors

MAM. Sesmu ArbousLeiden University AMA. E. E. MeursingErasmus MC - Sophia Children’s Hospital JKJack W. van KleefLeiden University

Discussion

Member takes

Implication

Should not yet change anesthesia staffing; hypothesis-generating for continuous anesthesiologist presence reducing early postoperative coma or death.

Key Points

To identify specific risk and protective factors in anesthesia management associated with 24-hour postoperative severe morbidity and mortality.
Conducted a case-control study nested within a cohort of 869,483 patients receiving anesthesia between 1995 and 1997.
Analyzed 807 cases (patients remaining comatose or dying within 24 hours of anesthesia) and 883 controls using data from structured anesthesia and recovery records.
Calculated confounder-adjusted odds ratios (OR) for anesthesia management variables.
The incidence of 24-hour postoperative death was 8.8 per 10,000 anesthetics (95% CI, 8.2–9.5), while postoperative coma incidence was 0.5 per 10,000 anesthetics (95% CI, 0.3–0.6).
Statistically significant risk reductions occurred with checklist equipment verification (OR 0.64), equipment check documentation (OR 0.61), directly available anesthesiologists (OR 0.46), absence of intraoperative anesthesiologist change (OR 0.44), full-time anesthetic nurse presence (OR 0.41), and two persons present at emergence (OR 0.69).
Pharmacological factors associated with reduced risk included reversal of muscle relaxants alone (OR 0.10) or combined with opiates (OR 0.29), as well as postoperative analgesia, especially when administered epidurally or intramuscularly rather than intravenously.

Structured PICO

Do specific anesthesia management practices reduce the risk of 24-hour postoperative severe morbidity and mortality in patients undergoing anesthesia?

Population

869,483 patients undergoing anesthesia (1995-1997), from which 807 cases (comatose or died within 24 hours) and 883 controls were analyzed.

Intervention

Specific anesthesia management practices (e.g., equipment check with protocol, directly available anesthesiologist, no change of anesthesiologist, reversal of anesthesia, postoperative pain medication)

Comparator

Absence of these specific anesthesia management practices

Outcome

Severe morbidity (coma) or mortality during or within 24 hours of undergoing anesthesiahard clinical

Specific anesthesia management factors, including continuous presence of the same anesthesiologist and protocolized equipment checks, are associated with significantly reduced 24-hour postoperative mortality and coma.

Cite This Study

Arbous et al. (2005) studied this question.

synapsesocial.com/papers/6a1bc8e5ea84844e355ef471 https://doi.org/10.1097/00000542-200502000-00005

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Implication

Should not yet change anesthesia staffing; hypothesis-generating for continuous anesthesiologist presence reducing early postoperative coma or death.

Impact of Anesthesia Management Characteristics on Severe Morbidity and Mortality

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Impact of Anesthesia Management Characteristics on Severe Morbidity and Mortality

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

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