Severe outcomes of pediatric perioperative adverse events occurring in operating rooms compared to off‐site anesthetizing locations in the Wake Up Safe Database
Uffman et al present a retrospective analysis of data from the Wake Up Safe paediatric anaesthesia registry in the US. They aim to quantify differences in perioperative risk attributable to location (operating theatres vs off-the-floor) for cases having an anaesthetic in the care of anaesthesia care providers. During 2010-2015 the registry collated data from 2,130,089 anaesthetics across 24 institutions, including 1594 eligible adverse events (AE). The combined primary outcome measure was severe AE defined as escalation of care (outpatient to inpatient, or ward to ICU), harm of any kind, or death. There was general consistency across the data, with approximately 20% of total cases and approximately 20% of severe AEs occurring off-the-floor. While a slightly increased odds of severe AE occurring off-the-floor (1.31 [CI]: 1.01, 1.69; P = 0.044) was found, when cardiac catheterisation cases were removed from analysis the odds normalised. It is well recognised in the literature that patients requiring cardiac catheterisation are a subgroup of children with significantly elevated perioperative risk. This study is weakened by the limitations of registry data sets, including selection bias (under/over reporting) and health service coding issues. Importantly, the reporting of comorbidities was not standardised and so this could not be included in analysis. Furthermore, the definition of severe AE in this study precludes patients already in ICU and thus any interpretation of the study premise for these patients. As a result, it cannot really consider the important question of how much safer it might be to electively manage the sickest patients in an operating theatre environment rather than off-the-floor.
Take home message
When delivered by an anaesthetist and in the current case mix, anaesthetising children appears to be equally safe whether it is in the operating theatre or an off-the-floor location. Paediatric cardiac catheterisation continues to be an area with substantial perioperative risk, with further examination needed to enumerate this further.
Reviewed by: Bae Corlette