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ECONOMICS AND HEALTH SYSTEMS RESEARCH

The Impact of Minor Perioperative Anesthesia-Related Incidents, Events, and Complications on Postanesthesia Care Unit Utilization

Ulrich Bothner, MD^*,, Michael Georgieff, MD, PhD^*, and Bernhard Schwilk, MD^*

*Department of Anesthesiology and Intensive Care Medicine, University of Ulm, Ulm, Germany; and Department of Medical Informatics, University of Utah, Salt Lake City, Utah

Address correspondence and reprint requests to Ulrich Bothner, MD, Department of Medical Informatics, University of Utah, School of Medicine AB193, Salt Lake City, UT 84132. Address e-mail to ulrich.bothner{at}m.cc.utah.edu

The German Society of Anesthesiology and Intensive Care Medicine evaluates the standardized and routine reporting of perioperative anesthesia-related incidents, events, and complications (IEC). As part of the long-term project’s definitions, IECs are graded according to severity and to their clinical consequence on further postanesthesia monitoring and treatment demands. The adult study population of our department comprised 37,079 patients recovering from anesthesia in a tertiary university hospital from July 1992 through June 1997. Cardiac, obstetric, craniotomy, thoracotomy, laparotomy, and emergency operations were excluded. Multivariate regression statistics were used to calibrate the impact of minor graded IECs on necessary postanesthesia care unit (PACU) utilization. Minor and severe IECs appeared in 22.1% and 0.2% of the patients. A minor IEC occurrence was a statistically significant (P < 0.001) predictor of PACU utilization in a multivariate regression model. The mean difference of PACU length of stay for patients with minor IECs was prolonged by a range of 6%–26% when adjusted for coexisting severity features such as age, gender, ASA physical status, and type and duration of anesthesia and surgery. We conclude that the IEC methodology integrates epidemiologic information about perioperative anesthesia outcome. Minor but frequently occurring IECs have an impact on PACU utilization and are thus important to measure and follow.

Implications: It is desirable to know how anesthesia-related incidents, events, and complications influence postanesthesia care. Analyses of standardized and routine perioperative outcome data, as proposed by the German anesthesia quality project, can show that even minor events consume relevant resources and are thus important to measure and follow.

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