Why the study?
Does anesthesia outside the operating room increase the risk of intraoperative adverse events compared to anesthesia in the operating room in children?
Does anesthesia outside the operating room increase the risk of intraoperative adverse events compared to anesthesia in the operating room in children?
In children receiving anesthesia, the incidence of intraoperative adverse events is comparable between operating room and non-operating room locations, with risk primarily driven by younger age and higher ASA status.
Comparable AE rates in NORA vs ORA should not yet alter practice; leaves open prospective validation of age and ASA as primary risk drivers.
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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Kakavouli et al. (2009) studied this question.
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