Zgleszewski Steven E, Graham Dionne A, Hickey Paul R, Brustowicz Robert M, Odegard Kirsten C, Koka Rahul, Seefelder Christian, Navedo Andres T, Randolph Adrienne G
From the *Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts; and †Center for Patient Safety and Quality Research, Boston Children's Hospital, Boston, Massachusetts.
Anesth Analg. 2016 Feb;122(2):482-9. doi: 10.1213/ANE.0000000000001059.
Pediatric anesthesia-related cardiac arrest (ARCA) is an uncommon but potentially preventable adverse event. Infants and children with more severe underlying disease are at highest risk. We aimed to identify system- and anesthesiologist-related risk factors for ARCA.
We analyzed a prospectively collected patient cohort data set of anesthetics administered from 2000 to 2011 to children at a large tertiary pediatric hospital. Pre-procedure systemic disease level was characterized by ASA physical status (ASA-PS). Two reviewers independently reviewed cardiac arrests and categorized their anesthesia relatedness. Factors associated with ARCA in the univariate analyses were identified for reevaluation after adjustment for patient age and ASA-PS.
Cardiac arrest occurred in 142 of 276,209 anesthetics (incidence 5.1/10,000 anesthetics); 72 (2.6/10,000 anesthetics) were classified as anesthesia-related. In the univariate analyses, risk of ARCA was much higher in cardiac patients and for anesthesiologists with lower annual caseload and/or fewer annual days delivering anesthetics (all P < 0.001). Anesthesiologists with the highest academic rank and years of experience also had higher odds of ARCA (P = 0.02). After risk adjustment for ASA-PS ≥ III and age ≤ 6 months, however, the association with lower annual days delivering anesthetics remained (P = 0.03), but the other factors were no longer significant.
Case-mix explained most associations between higher risk of pediatric ARCA and anesthesiologist-related variables at our institution, but the association with fewer annual days delivering anesthetics remained. Our findings highlight the need for rigorous adjustment for patient risk factors in anesthesia patient safety studies.
小儿麻醉相关心脏骤停（ARCA）是一种罕见但有可能预防的不良事件。患有更严重基础疾病的婴幼儿风险最高。我们旨在确定与ARCA相关的系统和麻醉医生相关风险因素。
我们分析了一家大型三级儿童医院2000年至2011年期间前瞻性收集的儿童麻醉患者队列数据集。术前全身疾病水平以美国麻醉医师协会身体状况（ASA-PS）为特征。两名评审员独立审查心脏骤停情况并对其与麻醉的相关性进行分类。在对患者年龄和ASA-PS进行调整后，确定单因素分析中与ARCA相关的因素以便重新评估。
在276,209例麻醉中，有142例发生心脏骤停（发生率为5.1/10,000例麻醉）；72例（2.6/10,000例麻醉）被归类为与麻醉相关。在单因素分析中，心脏病患者以及年病例量较低和/或每年麻醉天数较少的麻醉医生发生ARCA的风险要高得多（所有P<0.001）。学术级别最高且经验年限最长的麻醉医生发生ARCA的几率也更高（P = 0.02）。然而，在对ASA-PS≥III和年龄≤6个月进行风险调整后，与每年麻醉天数较少的相关性仍然存在（P = 0.03），但其他因素不再具有统计学意义。
病例组合解释了我们机构小儿ARCA较高风险与麻醉医生相关变量之间的大多数关联，但与每年麻醉天数较少的关联仍然存在。我们的研究结果强调在麻醉患者安全研究中需要对患者风险因素进行严格调整。
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