Severe outcomes of pediatric perioperative adverse events occurring in operating rooms compared to off‐site anesthetizing locations in the Wake Up Safe Database

Uffman, Joshua C.; Tumin, Dmitry; Beltran, Ralph J; Tobias, Joseph D.

doi:10.1111/pan.13549

Cited by 14 publications

(17 citation statements)

References 25 publications

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“…There were 1594 events, of which 362 were associated with NORA locations. Adverse events in cardiac catheterization suites had higher odds of severe outcome compared to the operating room, but this difference was not found in other off-site locations [32]. However, other groups have reported a lower incidence of critical events at off-site locations compared to the operating room [9,10].…”

Section: Non-operating Room Anesthesia (Nora)/sedationmentioning

confidence: 88%

Hot Topics in Safety for Pediatric Anesthesia

et al. 2020

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Anesthesiology is one of the leading medical specialties in patient safety. Pediatric anesthesiology is inherently higher risk than adult anesthesia due to differences in the physiology in children. In this review, we aimed to describe the highest yield safety topics for pediatric anesthesia and efforts to ameliorate risk. Conclusions: Pediatric anesthesiology has made great strides in patient perioperative safety with initiatives including the creation of a specialty society, quality and safety committees, large multi-institutional research efforts, and quality improvement initiatives. Common pediatric peri-operative events are now monitored with multi-institution and organization collaborative efforts, such as Wake Up Safe.

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Section: Non-operating Room Anesthesia (Nora)/sedationmentioning

confidence: 88%

Hot Topics in Safety for Pediatric Anesthesia

et al. 2020

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“…The most recent retrospective study using the WUS database concluded that the likelihood of severe outcomes for adverse events occurring in off‐site locations is not statistically different as compared with adverse events occurring in the OR 11 . However, given the trend of increased need for anesthesia services and off‐site sedation for diagnostic imaging, these cases will continue to increase in the pediatric population.…”

Section: Discussionmentioning

confidence: 99%

“…Before inclusion, reporting institutions analyze each event using a standardized root cause analysis method to evaluate the reasons responsible for the adverse event and determine the degree of preventability. Published data using WUS registry have included medication errors, cardiac arrests in the postanesthesia care unit (PACU), and severe adverse events in off‐site locations 7‐12 …”

Section: Methodsmentioning

confidence: 99%

Perioperative anaphylaxis in children: A report from the Wake‐Up Safe collaborative

Wakimoto

Miller

Kim

et al. 2021

Pediatric Anesthesia

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Background Anaphylactic reactions to antigens in the perioperative environment are uncommon, but they have a potential to lead to serious morbidity and/or mortality. The incidence of anaphylactic reactions is 1:37 000 pediatric anesthetics, and substantially less than the 1:10 000 to 1:20 000 incidence in the adult population. Neuromuscular blocking agents, latex, and antibiotics are the most frequently cited triggers. To date, there is no comprehensive report on perioperative anaphylactic reactions in children in the United States. Using the Wake‐up Safe database, we examined the incidence and consequences of reported perioperative anaphylaxis events. Methods We reviewed the Wake‐up Safe database from 2010 to 2017 and identified all reported instances of anaphylaxis. The triggering agent, timing, and location of the registered event, severity of patient harm, and preventability were identified. Narrative review of free‐text comments entered by reporting centers was performed to determine presenting symptoms, and interventions required. Type of case was identified from procedure codes provided in mandatory fields. Results Among 2 261 749 cases reported to the Wake‐up Safe database during the study period, perioperative anaphylactic reactions occurred in 1:36 479 (0.003%). Antibiotics, neuromuscular blocking agents, and opioid analgesics were the main triggers. Forty‐nine cases (79%) occurred in the operating room, and 13 cases (21%) occurred in off‐site locations. Seven (11%) patients required cardiopulmonary resuscitation following the onset of symptoms. Thirty‐five (57%) patients were treated with epinephrine or epinephrine plus other medications, whereas 5% were managed only with phenylephrine. Most cases (97%) required escalation of care after the event. Regarding case preventability, 91% of cases were marked as either “likely could not have been prevented” or “almost certainly could not have been prevented.” Conclusion The estimated incidence of anaphylaxis and inciting agents among the pediatric population in this study were consistent with the most recent published studies outside of the United States; however, new findings included need for cardiopulmonary resuscitation in 11% of cases, and estimated fatality of 1.6%. The management of perioperative anaphylaxis could be improved for some cases as epinephrine was not administered, or its administration was delayed. Fewer than half of reported cases had additional investigation to formally identify the responsible agent.

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“…Another study comparing severe AEs in NORA and OR from 2010 to 2015 using the Wake Up Safe Database found 50% of AEs were classified as severe in the OR and 58% in NORA locations. 36 Adverse events in cardiac catheterisation suite had a higher likelihood of severe AE than OR (adjusted odds ratio [AOR]¼1.48; 95% confidence interval [CI]: 1.05e2.08; P¼0.025). However, the occurrence of an AE at a site other than the cardiac catheterisation laboratory was not associated with a greater likelihood of a severe outcome vs one in the OR (AOR¼1/16; 95% CI: 0.82e1.66; P¼0.401).…”

Section: Mortality Morbidity and Adverse Outcomes In Noramentioning

confidence: 99%

“…1,19,22,23,30,38 Organisational challenges noted included lack of essential equipment, 14,16,22,27,30 such as PACUs not equipped to care for a patient with a left ventricle assist device. Other organisation challenges included lack of backup medication, 3,4,23 nonstandardised workstation setups, 1,26,32,34,36 and inexperienced postoperative care team. 17,26,37,38…”

Section: System Safety and Risks In Noramentioning

confidence: 99%

Morbidity, mortality, and systems safety in non-operating room anaesthesia: a narrative review

Herman

Jaruzel

Lawton

et al. 2021

British Journal of Anaesthesia

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Non-operating room anaesthesia (NORA) describes anaesthesia delivered outside a traditional operating room (OR) setting. Non-operating room anaesthesia cases have increased significantly in the last 20 yr and are projected to account for half of all anaesthetics delivered in the next decade. In contrast to most other medication administration contexts, NORA is performed in high-volume fast-paced environments not optimised for anaesthesia care. These predisposing factors combined with increasing case volume, less provider experience, and higher-acuity patients increase the potential for preventable adverse events. Our narrative review examines morbidity and mortality in NORA settings compared with the OR and the systems factors impacting safety in NORA. A review of the literature from January 1, 1994 to March 5, 2021 was conducted using PubMed, CINAHL, Scopus, and ProQuest. After completing abstract screening and full-text review, 30 articles were selected for inclusion. These articles suggested higher rates of morbidity and mortality in NORA cases compared with OR cases. This included a higher proportion of death claims and complications attributable to inadequate oxygenation, and a higher likelihood that adverse events are preventable. Despite relatively few attempts to quantify safety concerns, it was possible to find a range of systems safety concerns repeated across multiple studies, including insufficient lighting, noise, cramped workspace, and restricted access to patients. Old and unfamiliar equipment, lack of team familiarity, and limited preoperative evaluation are also commonly noted challenges. Applying a systems view of safety, it is possible to suggest a range of methods to improve NORA safety and performance.

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Severe outcomes of pediatric perioperative adverse events occurring in operating rooms compared to off‐site anesthetizing locations in the Wake Up Safe Database

Cited by 14 publications

References 25 publications

Hot Topics in Safety for Pediatric Anesthesia

Hot Topics in Safety for Pediatric Anesthesia

Perioperative anaphylaxis in children: A report from the Wake‐Up Safe collaborative

Morbidity, mortality, and systems safety in non-operating room anaesthesia: a narrative review

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