Kuo Yi-Wei, Lu I-Cheng, Yang Hui-Ying, Chiu Shun-Li, Hsu Hung-Te, Cheng Kuang-I
Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC.
Department of Anesthesiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC.
J Chin Med Assoc. 2016 Dec;79(12):678-682. doi: 10.1016/j.jcma.2016.01.021. Epub 2016 Oct 27.
Perioperative dental injury (PDI) is a common adverse event associated with anesthesia that can easily lead to medicolegal litigation. A quality improvement program was conducted with the electronic, standardized dental chart to document dentition before anesthesia and dentist consultation when necessary. This study aimed to reduce PDIs through execution of a quality improvement program.
We reviewed the 42-month interval anesthetic records of 64,718 patients who underwent anesthesia. A standardized electronic dental chart was designed to identify any dental prosthetics, fixed and removable dentures, and degree of loose teeth. The incidence of dental injuries associated with anesthesia was separated into three time periods: baseline, initiative (Phase I), and execution (Phase II). Primary outcome measurement was the incidence of PDIs related to anesthesia.
The overall incidence of dental injury related to anesthesia was 0.059% (38/64,718 patients). During the baseline period, the dental injury rate was 0.108% (26/24,137 patients), and it decreased from 0.051% in the initiative period (10/19,711 patients) to 0.009% in the execution period (2/20,870 patients) during implementation of the quality improvement program. Most dental injuries were associated with laryngeal mask airway (42.1%) and laryngoscopy (28.9%). The most commonly involved teeth were the upper incisors.
Dental injury incidence was significantly reduced and remained at low levels after implementation of the quality improvement program. We suggest the implementation of a standardized dental examination into the preoperative evaluation system adding pathologic teeth fixed or protected devices to minimize dental injury associated with anesthesia.
围手术期牙齿损伤（PDI）是一种与麻醉相关的常见不良事件，很容易引发医疗法律诉讼。我们开展了一项质量改进项目，使用电子化的标准化牙科图表在麻醉前记录牙列情况，并在必要时咨询牙医。本研究旨在通过实施质量改进项目来减少围手术期牙齿损伤。
我们回顾了64718例接受麻醉患者的42个月期间的麻醉记录。设计了一份标准化的电子牙科图表，以识别任何假牙、固定和活动假牙以及牙齿松动程度。与麻醉相关的牙齿损伤发生率分为三个时间段：基线期、主动期（第一阶段）和执行期（第二阶段）。主要结局指标是与麻醉相关的围手术期牙齿损伤的发生率。
与麻醉相关的牙齿损伤的总体发生率为0.059%（38/64718例患者）。在基线期，牙齿损伤率为0.108%（26/24137例患者），在质量改进项目实施期间，从主动期的0.051%（10/19711例患者）降至执行期的0.009%（2/20870例患者）。大多数牙齿损伤与喉罩气道（42.1%）和喉镜检查（28.9%）有关。最常受累的牙齿是上颌切牙。
实施质量改进项目后，牙齿损伤发生率显著降低并维持在较低水平。我们建议在术前评估系统中实施标准化牙科检查，并增加对病理性牙齿的固定或保护装置，以尽量减少与麻醉相关的牙齿损伤。
