Abstract

NM-326

Reporting Adverse Events in Children Undergoing General Anesthesia Using An Electronic Database

Lin A, Almeida-Chen G, Lee K, Thumm B, Fan W, Herrera J, Sun L
Columbia University Medical Center, New York, NY, USA

Introduction: We have previously reported adverse events (AE) in children receiving general anesthesia both in and outside the operating room (OR). We reported a 3.5% incidence of AEs from May 1, 2006 through September 30, 2007 (1). After this initial report, we have further revised the data reporting mechanism. We now report a summary of the AEs from our institution from 9/1/2009 to 5/19/2017.

Methods: The study received Institutional Review Board approval. Data were collected on every patient who received anesthesia provided by a pediatric anesthesia faculty from 9/1/2009 through 5/19/2017. We excluded data that had incomplete information and from patients over 21 years of age. Data were analyzed on: service, location, scheduled vs. unscheduled procedure, age, ASA physical status, and presence and category of AE.

Results: A total of 75,226 entries were included in the analysis. The overall incidence of AE was 2.8%. The incidence was 3.3% in the OR and 1.9%, in anesthetizing locations outside the OR (NOR), respectively. The annual AE incidence declined steadily from 6% in 2009 to 2% in 2012, and remained at 2% until 2017. An overall decrease in AE incidence was seen in all age groups (less than 1 month, 1-12 months, 1-6 years, 6-12 years, and 12 or more years of age). A year-to-year decrease in overall AE incidence was seen in all age groups (less than 1 month, 1-12 months, 1-6 years, 6-12 years, and 12 or more years of age) from 2009 to 2012. From 2012 to 2017, an increase in AE incidence was observed In neonates, but not in the other age groups.
There were a total of 2,266 AEs in the study. Of these, respiratory events accounted for 51.9% with an increasing trend from 40.9% in 2009 to 60.8% in 2017. Cardiac events accounted for 9.75% and also showed an increasing trend from 5.5% to 13.6%.

Discussion: At our institution, the overall AE incidence of 2.8% is similar to our previous findings and to other pediatric studies (1,2). The higher OR AE incidence than NOR AE incidence is also consistent with our earlier findings. There has been a reduction over the past eight years in AE incidence, which may be secondary to improved safety measures, better teaching and training, and newer technology. When stratified by age group, each showed this improvement except for neonates. Future analysis into this subgroup is planned. In recent years, there may be a higher ASA physical status in nonoperating room locations such as the cardiac catheterization lab.

References: 1. Kakavoulia, A, et. al. “Intraoperative reported adverse events in children,”Pediatric Anesthesia 2009; 19: 732-739. 2. Murat, I, et. al. “Perioperative anaesthetic morbidity in children: a database of 24,165 anaesthetics over a 30-month period,” Pediatric Anesthesia 2004; 14: 158-166.