Comparison of Safety Profiles between Non-operating Room Anesthesia and Operating Room Anesthesia: a Study of 199,764 Cases at a Korean Tertiary Hospital

Abstract

BackgroundDespite expanding demands for non-operating room anesthesia (NORA) worldwide, studies in this field are scarce. We compared the overall characteristics and the nature of deaths occurring within 48 hours after surgery between NORA and operating room anesthesia (ORA) cases at a Korean tertiary hospital.MethodsWe retrospectively analyzed the medical records of patients who underwent surgical procedures under anesthesia services in and outside the operating room from January 2013 to November 2017. All of the mortalities were categorized by principal cause into groups such as patient disease or condition, surgery, anesthesia, and others.ResultsOverall, 16,383 NORA cases and 183,381 ORA cases were analyzed. Eighty-six deaths were identified. The mortality rate of NORA cases was similar to that of ORA cases (4.9 per 10,000 cases [95% confidence interval (CI), 2.1–9.6] vs. 4.3 per 10,000 cases [95% CI, 3.4–5.3], respectively). Similar to ORA cases, higher American Society of Anesthesiologists physical status and very young age (< 2 years) were significantly associated with mortality in NORA cases. A patient's disease or condition was the most important cause of mortality (65/86, 75.6%), followed by surgery-related causes (16/86, 18.6%). Two cases of anesthesia-related mortality were only identified in the ORA cases, resulting in an overall anesthesia-related mortality of 0.1 per 10,000 cases (95% CI, 0.0–0.4).ConclusionAlthough NORA cases showed an equivalent perioperative mortality rate compared to ORA cases, there may be more room for improving patient safety when considering their favorable characteristics (healthier patients, less invasive and shorter procedures).Trial RegistrationClinical Research Information Service Identifier: KCT0002719

Age as a decisive factor in general anaesthesia use in paediatric proton beam therapy

“…Treatments requiring general anaesthesia, besides surgical operation, include cardiovascular catheterisation such as ablation, stent graft interpolation, endovascular treatment, radiological embolisation, gamma knife, and proton beam therapy (PBT) 2 . Performing general anaesthesia outside the operating room raises safety and quality issues due to the limited availability of equipment and anaesthesiologists, who might not be available in case of an emergency 3 , 4 .…”

Nonoperating room anaesthesia: safety, monitoring, cognitive aids and severe acute respiratory syndrome coronavirus 2

“…Claims for adverse respiratory events, including hypoventilation, aspiration and difficult intubation, occurred with at least twice the frequency [10]. Poor outcomes were often associated with suboptimal care and nonadherence to safe practice [10,11].…”

“…Deepening sedation by nonanaesthesiologists can rapidly lead to general anaesthesia [ 21 , 22 ] (Table 2 ) and training may not always be adequate for the task. A review of the Korean Society of Anesthesiology database from 2009 to 2014 revealed avoidable complications in 34 of 39 cases, 92.4% involving nonanaesthesiologists [ 11 ].…”

“…All NORA cases were under the care of a dedicated NORA-experienced anaesthesiologist. In comparison, an analysis of anaesthesia-related medical disputes between 2009 and 2014 in a Korean Society of Anesthesiologists Database found a disproportionate number of poor patient outcomes occurred after procedural sedation, the majority conducted by nonanaesthesiologists, and commonly associated with deficiencies in preprocedural testing, intraprocedural monitoring and documentation [ 11 ]. However, it is worth noting that more recently, Chang et al [ 15 ] reported a lower complication rate for NORA procedures from examination of the National Anesthesia Clinical Outcomes Registry.…”

Age as a decisive factor in general anesthesia use in pediatric proton beam therapy.

“…catheterization such as ablation, stent graft interpolation, endovascular treatment, radiological embolization, gamma knife and proton beam therapy (PBT) (2). Performing general anesthesia outside the operating room raises safety and quality issues due to the limited availability of equipment and anesthesiologists, who might not be available in case of an emergency (3,4).…”