Anesthesia-Related Airway Patient Safety Incidents Correlated with Major Adverse Cardiac Events: A Single-Center Retrospective Case-Control Analysis from 2009 to 2019

Abstract

Background: Airway-related patient safety incidents (PSIs) have always been the top concern of anesthesiologists because this type of incident could severely threaten patient safety if not treated immediately and properly. This study aimed to reveal the composition and outcomes of and to identify risk factors related to airway incidents reported by anesthesiologists.Methods: All airway-related PSIs reported by anesthesiologists at a Chinese academic hospital between September 2009 and August 2019 were collected from the PSI reporting system. Patients with reported airway incidents were matched 1:1 with controls based on sex and type of surgery. Univariate and multivariate analyses were performed to identify risk factors associated with airway incident occurrence and to evaluate the influence of airway PSIs on the prognosis.Results: Among 773 PSIs voluntarily reported by anesthesiologists during the study period, 208 (26.9%) were airway-related incidents, with an overall reporting incidence of 4.59 per 10,000. In patients with reported airway PSIs, postoperative major adverse cardiac events (MACEs) were more likely (7 vs 1 case, odds ratio: 7.37 [95% confidence interval (CI): 0.89 to 60.83], p=0.031) and the extubation time (0.82±1.63 d vs 0.21±0.89 d, mean difference: 0.61 d [95% CI: 0.28 to 0.95 d], p<0.001) and ICU length of stay (LOS) (2.03±6.66 d vs 0.22±0.96 d, mean difference 1.81 d [95% CI: 0.60 to 3.02 d], p=0.004) were longer. Only the American Society of Anesthesiologists (ASA) physical status was found to be a significant independent predictor of these airway PSIs.Conclusions: This single-institutional retrospective case-control study describes the composition of airway-related PSIs reported by anesthesiologists within eleven years. Airway incidents influence the prognosis by increasing the incidence of postoperative MACEs and prolonging both the extubation time and ICU LOS. Airway PSI data are worth analyzing to improve patient safety.