Gibbs N M, Culwick M D, Merry A F
Chair, Australian and New Zealand Tripartite Anaesthesia Data Committee, Anaesthetist, Department of Anaesthesia, Sir Charles Gairdner Hospital, Perth, Western Australia.
Medical Director, Australian and New Zealand Tripartite Anaesthesia Data Committee, Anaesthetist, Department of Anaesthesia, Royal Brisbane and Women's Hospital, Brisbane, Queensland.
Anaesth Intensive Care. 2017 Mar;45(2):159-165. doi: 10.1177/0310057X1704500205.
This report describes an analysis of patient and procedural factors associated with a higher proportion of harm or death versus no harm in the first 4,000 incidents reported to webAIRS. The report is supplementary to a previous cross-sectional report on the first 4,000 incidents reported to webAIRS. The aim of this analysis was to identify potential patient or procedural factors that are more common in incidents resulting in harm or death than in incidents with more benign outcomes. There was a >50% higher proportion of harm (versus no harm) for incidents in which the patient's body mass index (BMI) was <18.5 kg/m, for incidents in post-anaesthesia care units and non-theatre procedural areas, and for incidents under the main category of cardiovascular or neurological. The proportion of incidents associated with death was also higher (risk ratio >1.5) for BMI <18.5 kg/m, incidents in non-theatre procedural areas, and incidents under the main category of cardiovascular or neurological. In addition, the proportion of incidents associated with death was higher for incidents in which the patient's age was >80 years, the American Society of Anesthesiologists physical status was 4 or 5, incidents involving non-elective procedures, and incidents occurring after hours (1800 to 0800 hours). When faced with incidents with these potential risk factors, anaesthetists should consider earlier interventions and request assistance at an earlier stage. Educational strategies on incident prevention and management should place even further emphasis on scenarios involving these factors.
本报告描述了对上报至webAIRS的前4000起事件中与较高伤害或死亡比例（相对于无伤害）相关的患者和手术因素的分析。该报告是之前一份关于上报至webAIRS的前4000起事件的横断面报告的补充。本分析的目的是确定在导致伤害或死亡的事件中比在结果更良性的事件中更常见的潜在患者或手术因素。对于患者体重指数（BMI）<18.5kg/m²的事件、麻醉后护理单元和非手术室手术区域的事件以及心血管或神经科主要类别下的事件，伤害（相对于无伤害）的比例高出50%以上。对于BMI<18.5kg/m²的事件、非手术室手术区域的事件以及心血管或神经科主要类别下的事件，与死亡相关的事件比例也更高（风险比>1.5）。此外，对于患者年龄>80岁、美国麻醉医师协会身体状况为4或5、涉及非择期手术的事件以及非工作时间（18:00至08:00）发生的事件，与死亡相关的事件比例更高。当面对具有这些潜在风险因素的事件时，麻醉师应考虑更早进行干预并在更早阶段请求援助。关于事件预防和管理的教育策略应更加重视涉及这些因素的情况。
