The investigation, published in the journal Anaesthesiawas the RCA’s seventh national audit project (seventh national audit project, NAP7) and covered more than 20,000 procedures in more than 350 hospital centers. NAPs study rare but potentially serious complications related to anesthesia and aim to improve practices. Each project focuses on a different topic and the NAP7 project looked at perioperative cardiac arrest.
Higher complication rate during emergency surgeries
Lead author Dr Andrew Kane, consultant anesthetic at James Cook University Hospital in Middlesbrough and member of the Health Services Research Center (Health Services Research Center) of the RCA in London, said the new data presented “ the first estimates of the rates of potentially serious complications and critical incidents observed during modern anesthetic practice “. The data confirmed that individual complications are uncommon when performing elective surgeries, but highlights the relatively higher rate of complications in emergency situations.
As part of the NAP7 project, the survey team asked anesthetists to participate in a prospective online study consisting of recording anonymous information on all cases requiring general, regional or local anesthesia, sedation or other anesthesia care under supervision, provided in their establishment for four days.
Of the 416 hospitals invited to participate, 352 (85%) responded to the survey, with a total of 24,172 cases, including 1,922 “ distinct potentially serious complications » were reported in 1,337 cases (6%). Since obstetric cases had a high rate of major hemorrhage, they were excluded from further analysis.
In the remaining cohort of 20,996 non-obstetric cases, 1,705 potentially serious complications were reported (5.5%). There were single complications in 851 cases (4%), two complications in 166 cases (1%), and three or more complications in 133 cases (1%). Complications were classified as follows:
- Circulatory in nature (e.g.: severe hypotension or severe arrhythmias): 616 (36%)
- Related to the respiratory tract (e.g. low oxygen levels): 418 (25%)
- Metabolic in nature: 264 (15%)
- Relating to breathing (e.g. ventilation difficulties): 259 (15%)
- Of other nature: 107 (6%)
- Neurological in nature: 41 (2%)
“Uncommon” complications during elective surgeries
Complications related to elective non-obstetric surgeries were “ uncommon “, said the team, with a rate of 10 to 100 complications per 10,000 cases. On the other hand, emergency surgeries (of an urgent and immediate nature) represented 3,454 cases (16%), but resulted in 714 complications (42%), including severe hypotension, major hemorrhage, arrhythmias severe, septic shock, significant acidosis and electrolyte disturbances. Each of these complications was “ frequent », with a rate of 100 to 1,000 complications per 10,000 cases.
Univariate analysis showed that risk factors for complications included:
- Newborns (aged less than 28 days): 18%, a risk 3.8 times higher than young adults (19-25 years: 4.7%);
- Older ages:
- Adults aged 66 to 75: 6.0%, a 28% higher risk than young adults;
- Adults aged 76 to 85: 6.1%, a 30% higher risk;
- Adults aged over 85: 5.7%, a 21% higher risk;
- Higher comorbidity by American Society of Anesthesiology physical status (American Society of AnesthesiologyASA) ASA4 (major comorbidities): 19%, a risk 5.5 times higher than ASA1 status (fit and healthy, 3.5%);
- Men: 6.4%, i.e. a risk 40% higher than women (4.7%);
- Frailty: 8.5%, i.e. a doubling of the risk compared to non-frail patients (4.5%);
- Immediate emergency surgery (intervention aimed at saving a life, a limb or an organ at the same time as resuscitation): 39%, i.e. a risk 10 times higher than elective surgery (4%) and 4 times higher than emergency operations (intervention in cases of acute onset or clinical deterioration of life-threatening conditions, 8.8%);
- Complex major surgery (e.g. intestinal resection for cancer): 9%, a risk 2.5 times higher than minor surgery (e.g. removal of a lump on the skin, 3.4%) ;
- Night surgery: 20%, i.e. a risk 4 times higher than that of daytime operations (5%);
- Surgery on the weekend: Sunday (10%) or Saturday (6.5%), respectively a double risk and 30% higher than that of operations during the week (5%).
Risk factors often combine
The authors emphasized that these comparisons were univariate, whereas, generally, the factors interact. For example, at night and on weekends, only the most urgent cases are operated on, and these are often older, frail patients with comorbidities. Likewise, almost all surgical procedures on newborns are urgent and major, which partly explains the higher rate of complications.
Dr Jasmeet Soar, co-author of the study and consultant in anesthesia and intensive care medicine at Southmead Hospital in Bristol, said patients were generally older, had more co-morbidities and were more likely to be obese than 10 years ago. All these factors make anesthesia and surgery inherently more dangerous “.
The authors concluded by stating: “ These data represent rates of potentially serious complications during routine anesthesia care and may be useful for risk assessment and patient consent. »
Dr Fiona Donald, President of the Royal College of Anesthetists, commented on the report: “ The more we understand which patients are at increased risk of complications and why, the more we are able to improve perioperative care and this study takes us a long way toward understanding. »
This article was translated from Medscape.co.uk using multiple editorial tools, including AI, in the process. The content was reviewed by the editorial staff before publication.
