Up-to-date knowledge about the surgical population, the national burden of anesthesia, anesthetic methodologies, and associated trends is imperative for the systematic evaluation of productivity, policy formulation, and the identification of pertinent research avenues. In the UK, the Royal College of Anesthetists conducts a survey every 3-4 years as part of its National Audit Projects (NAP). The survey collects patient-level encounter data from all cases under the care of an anesthetist in hospitals delivering anesthesia across the country.
Recent findings from the 7th iteration of the National Audit Projects (NAP7), as reported in the journal Anaesthesia, reveal that potentially severe complications manifest in approximately one out of every 18 procedures supervised by an anesthetist. Identified risk factors associated with these potentially serious complications include infancy (neonates), the presence of comorbidities, male gender, heightened frailty, the urgency and complexity of the surgical intervention, and procedures conducted during nighttime or weekends. These insights contribute to a comprehensive understanding of the anesthesia landscape, facilitating informed decision-making, enhanced patient care, and the advancement of anesthesia-related research endeavors.
The researchers employed standard methods, obtained regulatory approvals, and utilized the details of the NAP7 activity survey questionnaire for the study. They extended invitations to all UK NHS hospitals providing anesthetic care to participate. The sites were allocated a continuous 4-day data collection period, with an equal likelihood of commencing on any day of the week, spanning from November 8 to November 24, 2021. The study encompassed all cases necessitating general anesthesia, regional anesthesia/analgesia, sedation, local anesthesia, or monitored anesthesia care.
Out of the 416 hospital sites invited to participate, 352 (85%) successfully completed the study. Within the 24,172 cases examined, 1,922 discrete potentially serious complications were reported during 1,337 (6%) cases. Obstetric cases, characterized by a notably high major hemorrhage rate, were subsequently excluded from further analysis. Among the remaining 20,996 non-obstetric cases, 1,705 complications were reported during 1,150 (5%) cases. Circulatory events constituted the majority of complications (616, 36%), followed by airway (418, 25%), metabolic (264, 15%), breathing (259, 15%), and neurological (41, 2%) events. A singular complication was reported in 851 (4%) cases, two complications in 166 (1%) cases, and three or more complications in 133 (1%) cases.
Kane and colleagues reported that in non-obstetric elective surgery, all complications were categorized as ‘uncommon’ (occurring at rates between 10 and 100 per 10,000 cases). Emergency surgery, including both urgent and immediate priority cases, represented 3,454 (16%) of non-obstetric cases but accounted for a substantial 714 (42%) of complications. Specific complications such as severe hypotension, major hemorrhage, severe arrhythmias, septic shock, significant acidosis, and electrolyte disturbances were classified as ‘common’ (with frequencies ranging from 100 to 1,000 per 10,000 cases) in the context of emergency surgeries.
The research concludes that these complications exhibit associations with various factors, including younger age, higher ASA physical status, male gender, increased frailty, the urgency and extent of surgery, as well as factors such as the day of the week and time of day. These findings offer valuable information for risk assessment and obtaining informed patient consent throughout the treatment process, thereby contributing to enhanced clinical decision-making and patient care in the field of anesthesia and surgery.
Reference
Kane AD, Cook TM, Armstrong RA, Kursumovic E, Davies MT, Agarwal S, et al. The incidence of potentially serious complications during non-obstetric anaesthetic practice in the United Kingdom: an analysis from the 7th National Audit Project (NAP7) activity survey. Anaesthesia [Internet]. [cited 2023 Dec 8].