Incidence and Contributing Factors of Anesthesia-Related Critical Events in Neurosurgery in a Tertiary Academic Hospital in a Developing Country: a Retrospective Study
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Abstract
Background and aim: Neurosurgery is regarded as high-risk surgery due to comorbidities of patients, urgency and complexities of procedures. Mostly, reported complications were surgical-related complications. Very few studies reported anesthesia-related complications. This study aims to determine the incidence and contributing factors of anesthesia-related complications in neurosurgical unit. Methods: Total 12,418 patients of this retrospective study had neurosurgical procedures during 7 years (2014-2020). Every incident report would be extensively reviewed by 3 investigators to classify the contributing factors of complications together with severities and outcomes. The immediate (first 24 hours) and delayed (7 days) outcomes were recorded. The outcomes were classified as complete recovery, prolonged ventilation, prolonged hospital stay, vegetative state and death. The descriptive analysis was used for the outcome. Results: There were 214 incidents of 184 patients per 12,418 anesthetics or 1.7%. Top five complications were lip trauma (53 events, 28.8%), difficult intubation (36 events, 19.6%), reintubation (23 events, 12.5%), dental injury (18 events, 9.8%), esophageal intubation (15 events, 8.2%). Top three contributing factors were inexperience (38.4%), inappropriate decision (17.8%) and patient factor (15.5%). Major complications such as death, cardiac arrest, stroke and convulsion were found in 23 cases, mostly related to patient factor, surgical factor and inappropriate decision. Nearly half (n=91, 44%) had complete recovery during immediate postoperative period. Conclusion: Airway complications were the most anesthesia-related complications in neuroanesthesia and the most contributing factor was inexperienced trainee. Attention should be focused on improving in-training in airway management and developing protocols to minimize human and system errors.
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