麻醉相关气道不良事件相关因素分析：一项2009至2022年单中心回顾性病例对照研究

doi:10.24920/004130

Abstract

Objective Airway-related patient safety incident (PSI) has always been the top concern of anesthesiologists because this type of incidents could severely threaten patient safety if not treated immediately and properly. This study intends to reveal the composition, prognosis, and to identify risk factors for airway related incidents reported by anesthesiologists.
Methods All airway related PSIs reported by anesthesiologists in a Chinese academic hospital between September 2009 and May 2022 were collected from the PSI reporting system. Patients with airway incidents reported were matched 1:1 with controls based on sex and type of surgery. Univariable and multivariable analysis were performed to find risk factors associated with airway incident occurrence, and to evaluate influence of airway PSIs on patient prognosis.
Results Among 1,038 PSIs voluntarily reported by anesthesiologists during the study period, 281 cases (27.1%) were airway-related incidents, with an overall reporting incidence of 4.74 per 10,000 among 592,884 anesthesia care episodes. Only ASA physical status was found to be significant independent predictor of these airway PSIs (P = 0.020). Patients with airway PSIs reported had longer extubation time (0.72 ± 1.56 d vs. 0.16 ± 0.77 d, 95%CI: 0.29 to 0.82, P < 0.001), longer ICU length of stay (LOS) (1.63 ± 5.71 d vs. 0.19 ± 0.84 d, 95%CI: 0.57 to 2.32, P= 0.001), longer post operative LOS (10.56 ± 13.09 d vs. 7.59 ± 10.76 d, 95%CI: 0.41 to 5.53, P = 0.023), and longer total in-hospital LOS (14.99 ± 15.18 d vs. 11.62 ± 11.88 d, 95%CI: 0.46 to 6.27,P = 0.024).
Conclusions This single-center retrospective case-control study describes the composition of airway-related PSIs reported by anesthesiologists within thirteen years. Airway incidents might influence patient prognosis by elongating extubation time and LOS. Airway PSI data were worth analyzing to improve patient safety.

Key words: composition, risk factor, airway, patient safety incident

Xue Zhang, Lingeer Wu, Huizhen Huang, Yuelun Zhang, Zhilong Lu, Yajie Tian, Le Shen, Yuguang Huang. Risk Factors for Anesthesia-Related Airway Patient Safety Incidents: A Single-Center Retrospective Case-Control Analysis from 2009 to 2022[J].Chinese Medical Sciences Journal, 2022, 37(4): 287-292.

Figures/Tables 4

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References 17

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Risk factors	Airway PSI group (n = 170)	Control group (n = 170)	Mean difference/OR (95%CI)	P value
Age (yrs, mean±SD)	54.63±??.49	52.63±??.52	2.00 (-1.10 to 5.10)	0.206
Height (cm, mean±SD)	165.27±8.62	165.80±?.47	-0.53 (-2.29 to 1.24)	0.559
Weight (kg, mean±SD)	66.13±3.19	64.75±?1.72	1.38 (-1.29 to 4.04)	0.310
BMI (kg/m², mean±SD)	24.09±?.25	23.54±?.41	0.55 (-0.29 to 1.40)	0.197
ASA PS (n)
Ⅰ	24	46	Reference
Ⅱ	112	110	1.59 (0.86 to 2.93)	0.137
Ⅲ	34	14	3.40 (1.42 to 8.11)	0.006
Preoperative comorbidities (n)
Hypertension	53	38	1.57 (0.97 to 2.56)	0.066
Diabetes	26	18	1.53 (0.80 to 2.90)	0.196
Smoking history (n)	44	42	1.06 (0.65 to 1.74)	0.803
Drinking history (n)	25	25	1.00 (0.55 to 1.82)	1.000
Preoperative laboratory test indices (mean±SD)
WBC (×10⁹/L)	6.55±1.96	6.52±2.47	0.03 (-0.45 to 0.50)	0.906
NEUT (%)	62.03±10.39	61.06±10.64	0.97 (-1.28 to 3.22)	0.396
LY (%)	28.12±9.32	29.23±9.42	-1.11 (-3.11 to 0.89)	0.276
HGB (g/L)	132.19±25.22	135.65±18.54	-3.46 (-8.19 to 1.28)	0.152
Hct (%)	39.84±5.51	40.27±4.97	-0.43 (-1.56 to 0.69)	0.446
PLT (×10⁹/L)	241.13±80.60	240.30±70.94	0.83 (-15.40 to 17.06)	0.920
ALT (U/L)	30.90±49.79	27.17±47.00	3.73 (-6.62 to 14.07)	0.479
Alb (g/L)	41.65±4.96	42.98±3.96	-1.32 (-2.29 to -0.36)	0.007
Serum Cr (μmol/L)	69.10±21.48	67.50±15.94	1.60 (-2.44 to 5.65)	0.437
PT (s)	11.83±0.99	11.64±1.14	0.18 (-0.04 to 0.41)	0.114
APTT (s)	27.96±3.96	27.05±3.25	1.03 (-0.01 to 2.07)	0.051
Fibrinogen (g/L)	3.28±1.26	2.99±0.89	0.29 (0.05 to 0.52)	0.016
Glucose (mmol/L)	5.70±1.28	5.64±1.50	0.05 (-0.25 to 0.35)	0.722

Groups	ASA PS (n)			Age (yrs)	Alb (g/L)	Fibrinogen (g/L)	BMI (kg/m²)	Hypertension (n)
Groups	Ⅰ	Ⅱ	Ⅲ	Age (yrs)	Alb (g/L)	Fibrinogen (g/L)	BMI (kg/m²)	Hypertension (n)
Control group	46	110	14	52.63±13.52	42.98±3.96	2.99±0.89	23.54±3.41	38
Airway PSI group	24	112	34	54.63±15.49	41.65±4.96	3.28±1.26	24.09±4.25	53
OR (95%CI)	Reference	1.65 (0.88 to 3.08)	3.50 (1.45 to 8.42)	1.00 (0.98 to 1.01)	0.97 (0.91 to 1.02)	1.16 (0.92 to 1.47)	1.04 (0.98 to 1.11)	1.16 (0.66 to 2.05)
P value	0.020			0.627	0.208	0.213	0.202	0.603

Groups	Extubation time (d, mean±SD)	ICU LOS (d, mean±SD)	Post-operative LOS (d, mean±SD)	In-hospital LOS (d, mean±SD)	Complications (n)
Groups	Extubation time (d, mean±SD)	ICU LOS (d, mean±SD)	Post-operative LOS (d, mean±SD)	In-hospital LOS (d, mean±SD)	Pulmonary infection	MACE
Control group	0.16±0.77	0.19±0.84	7.59±10.76	11.62±11.88	4	1
Airway PSI group	0.72±1.56	1.63±5.71	10.56±13.09	14.99±15.18	11	7
Mean difference/OR (95%CI)	0.55 (0.29 to 0.82)	1.44 (0.57 to 2.32)	2.97 (0.41 to 5.53)	3.37 (0.46 to 6.27)	2.87 (0.90 to 9.020)	7.26 (0.88 to 59.64)
P value	< 0.001	0.001	0.023	0.024	0.065	0.067

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