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Goldfuss S, Wittmann S, Würschinger F, Bitzinger D, Seyfried T, Holzamer A, Fischer M, Camboni D, Sinner B, Zausig YA. Anaesthesia-related complications and side-effects in TAVI: a retrospective study in Germany. BMJ Open 2019; 9:e025825. [PMID: 31048439 PMCID: PMC6501997 DOI: 10.1136/bmjopen-2018-025825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES This study was performed to analyse anaesthesia-related complications and side effects in patients undergoing transcatheter aortic valve implantation (TAVI) under general anaesthesia. DESIGN Retrospective study. SETTING The study was performed as a single-centre study in a hospital of tertiary care in Germany. PARTICIPANTS All 853 patients, who underwent TAVI at the Universitätsklinikum Regensburg between January 2009 and July 2015, were included. 52.5% were female patients. PRIMARY AND SECONDARY OUTCOME MEASURES We gathered information, such as recent illness, vital parameters and medication administered during the intervention and postoperatively for 12 hours. We analysed all anaesthesia-related complications and anaesthesia-related side effects that occurred during the intervention and entire hospital stay. RESULTS We analysed all 853 TAVI procedures. The mean patient age was 79 ± 6 years. In 99.5% of cases, we used volatile-based anaesthesia. 2.8% (n=24; transfemoral (TF): n=19 [3.8%]; transapical (TA): n=5 [1.4%]) of all cases suffered from anaesthesia-related complications. 819 (TF: n=447; TA: n=372) anaesthesia-related side effects occurred in 586 (68.7%, TF: n=325 [64.2%], TA: n=261 [75.2%]) patients. Neither the complications nor the side effects had any serious consequences. Intraoperative hypothermia in 44% of cases (TF: n=202 [39.9%]; TA: n=173 [49.9%]) and postoperative nausea and vomiting in 27% (n=232; TF: n=131 [25.9%], TA: n=101 [29.1%]) of cases were the most common anaesthesia-related side effects. CONCLUSION In this study, serious anaesthesia-related complications were rarely seen, and non-critical anaesthesia-related side effects could have been avoided through consistent prophylaxis and management. Therefore, despite their high anaesthetic risk, general anaesthesia is justifiable in patients who underwent TAVI.
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Affiliation(s)
- Sophia Goldfuss
- Department of Anaesthesiology, Universitatsklinikum Regensburg, Regensburg, Germany
| | - Sigrid Wittmann
- Department of Anaesthesiology, Universitatsklinikum Regensburg, Regensburg, Germany
| | - Fabian Würschinger
- Department of Anaesthesiology, Universitatsklinikum Regensburg, Regensburg, Germany
| | - Diane Bitzinger
- Department of Anaesthesiology, Universitatsklinikum Regensburg, Regensburg, Germany
| | - Timo Seyfried
- Department of Anaesthesiology, Universitatsklinikum Regensburg, Regensburg, Germany
| | - Andreas Holzamer
- Department of Cardiothoracic Surgery, Universitatsklinikum Regensburg, Regensburg, Germany
| | - Marcus Fischer
- Department of Cardiology, Universitatsklinikum Regensburg, Regensburg, Germany
| | - Daniele Camboni
- Department of Cardiothoracic Surgery, Universitatsklinikum Regensburg, Regensburg, Germany
| | - Barbara Sinner
- Department of Anaesthesiology, Universitatsklinikum Regensburg, Regensburg, Germany
| | - York Alexander Zausig
- Department of Anaesthesiology, Universitatsklinikum Regensburg, Regensburg, Germany
- Department of Anaesthesiology and Operative Intensive Care Medicine, Klinikum Aschaffenburg, Aschaffenburg, Germany
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Schiff JH, Welker A, Fohr B, Henn-Beilharz A, Bothner U, Van Aken H, Schleppers A, Baldering HJ, Heinrichs W. Major incidents and complications in otherwise healthy patients undergoing elective procedures: results based on 1.37 million anaesthetic procedures. Br J Anaesth 2014; 113:109-21. [PMID: 24801456 DOI: 10.1093/bja/aeu094] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Improved anaesthesia safety has made severe anaesthesia-related incidents, complications, and deaths rare events, but concern about morbidity and mortality in anaesthesia continues. This study examines possible severe adverse outcomes or death recorded in a large national surveillance system based on a core data set (CDS). METHODS Cases from 1999 to 2010 were filtered from the CDS database. Cases were defined as elective patients classified as ASA physical status grades I and II (without relevant risk factors) resulting in death or serious complication. Four experts reviewed the cases to determine anaesthetic involvement. RESULTS Of 1 374 678 otherwise healthy, ASA I and II patients in the CDS database, 36 met the study inclusion criteria resulting in a death or serious complication rate of 26.2 per million [95% confidence interval (CI), 19.4-34.6] procedures, and for those with possible direct anaesthetic involvement, 7.3 per million cases (95% CI, 3.9-12.3). CONCLUSIONS This is the first study assessing severe incidents and complications from a national outcome-tracking database. Annual identification and review of cases, perhaps with standardized database queries in the respective departments, might provide more detailed information about the cascades that lead to unfortunate outcomes.
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Affiliation(s)
- J H Schiff
- Department of Anaesthesia and Intensive Care, Katharinenkrankenhaus, Klinikum Stuttgart, Stuttgart, Germany James Cook University, Queensland, Australia
| | - A Welker
- Department of Anaesthesia, Dr-Horst-Schmidt-Kliniken, Wiesbaden, Germany
| | - B Fohr
- Department of Anaesthesia, University of Heidelberg, Heidelberg, Germany
| | - A Henn-Beilharz
- Department of Anaesthesia and Intensive Care, Katharinenkrankenhaus, Klinikum Stuttgart, Stuttgart, Germany
| | - U Bothner
- Department of Anaesthesia, Ulm University, Ulm, Germany
| | - H Van Aken
- Department of Anaesthesia and Intensive Care, University Hospital Muenster, Muenster, Germany
| | - A Schleppers
- DGAI (German Society of Anaesthesia and Intensive Care Medicine), Nuremberg, Germany
| | - H J Baldering
- AQAI (Applied Quality Assurance in Anaesthesia and Intensive-Care Medicine/Angewandte Qualitätssicherung in Anästhesie und Intensivmedizin, AQAI Ltd), Mainz, Germany
| | - W Heinrichs
- AQAI (Applied Quality Assurance in Anaesthesia and Intensive-Care Medicine/Angewandte Qualitätssicherung in Anästhesie und Intensivmedizin, AQAI Ltd), Mainz, Germany
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Gessmann J, Seybold D, Baecker H, Muhr G, Graf M. [Operative management and fracture care of the lower leg with the Ilizarov fixator in morbidly obese patients: literature review and results]. Chirurg 2008; 80:34-44. [PMID: 18853125 DOI: 10.1007/s00104-008-1629-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Given the rising prevalence of obesity, surgeons and hospitals must become more familiar with the treatment and operative management of obese patients. Several additional pre- and postoperative considerations must be involved such as appropriate assessment of comorbidities and requirements for special equipment. There are still very few data regarding morbidly obese patients with BMIs >50 kg/m(2). After a general literature review of operative management of obese patients, we report on fracture care of the lower limb in such patients with custom-made Ilizarov ring fixators. We found them suited to bear enormous weight-loading but that associated comborbidities can limit successful fracture care.
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Affiliation(s)
- J Gessmann
- Chirurgische Klinik und Poliklinik, Berufsgenossenschaftliche Kliniken Bergmannsheil, Ruhr-Universität Bochum, Bükle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland.
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Perka C, Paul C, Matziolis G. [Factors influencing perioperative morbidity and mortality in primary hip arthroplasty]. DER ORTHOPADE 2004; 33:715-20. [PMID: 15269876 DOI: 10.1007/s00132-003-0622-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION In the present study we examined preoperative parameters that may identify patients at high risk for postoperative complications after endoprosthetic joint replacement. MATERIALS AND METHODS The incidence of risk factors and perioperative complications in 628 primary hip arthroplasties (THA) (549 patients) was investigated in an unselected, retrospective study. Concomitant illnesses were found in 426 cases. Intra- and postoperative complications (93 specifically orthopedic and 42 common ones) were observed in 104 cases. RESULTS High risk scores based on Lutz and Klose criteria, a prolonged operation time, and the number of previous operations were significantly correlated to the incidence of postoperative complications. In contrast, obese patients had a significantly lower rate of intra- and postoperative complications and a diminished perioperative blood loss. THAs performed under intubation anesthesia led to a higher blood transfusion volume. The patient's age and the kind and quantity of concomitant illnesses did not influence the perioperative complication rate. CONCLUSION The complication rate of elective primary THAs is not dependent on risk factors suspected up to now such as advanced patient age or the kind and quantity of concomitant illnesses. High-risk patients can only be determined by complex scores, not by single parameters. Adiposity becomes a relevant economic factor only by dint of the prolonged operation time.
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Affiliation(s)
- C Perka
- Klinik für Orthopädie, Universitätsmedizin Berlin.
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Bothner U, Georgieff M, Schwilk B. The impact of minor perioperative anesthesia-related incidents, events, and complications on postanesthesia care unit utilization. Anesth Analg 1999; 89:506-13. [PMID: 10439776 DOI: 10.1097/00000539-199908000-00049] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
UNLABELLED 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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Affiliation(s)
- U Bothner
- Department of Anesthesiology and Intensive Care Medicine, University of Ulm, Germany.
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Bothner U, Georgieff M, Schwilk B. The Impact of Minor Perioperative Anesthesia-Related Incidents, Events, and Complications on Postanesthesia Care Unit Utilization. Anesth Analg 1999. [DOI: 10.1213/00000539-199908000-00049] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Bothner U, Georgieff M, Schwilk B. Validation of routine incidence reporting of one anaesthesia provider institution within a nation-wide quality of process assessment program. J Clin Monit Comput 1998; 14:305-11. [PMID: 9951755 DOI: 10.1023/a:1009922313572] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In 1992, a long-term project was launched by the German Society for Anaesthesiology and Intensive Care Medicine to render quality comparisons between anaesthesia providers. As one of the first volunteer centres, we established the standardised reporting of perioperative anaesthesia related incidents, events, and complications (IEC) in any routine anaesthetic procedure performed. This present study is aimed to explore the longitudinal stability of IEC recordings in one institution, which should be a prerequisite for valid external comparisons. Methods. The analyses were completed on an adult population of 49945 consecutive anaesthetic procedures with peripheral surgery from July 1992 until December 1996. Attribute quality control charts with monthly samples of an average of 954 anaesthetics were used to assess statistical variability of specific IEC incidences. Results. Average proportions were 20% for moderate IEC, 2.7% for severe IEC, 13% for moderate cardio-vascular IEC, 1.3% for severe cardio-vascular IEC, and 2.4% for respiratory IEC. Moderate IEC proportions showed considerable variability during the study period. A series of excess proportions was probably due to educational activities on documentation discipline. In contrast, clinically severe IEC proportions were rather stable. Stability of cardio-vascular IEC proportions resembled the picture of the overall IEC assessment. Monthly respiratory IEC proportions showed smallest variability during the study period. Discussion. Use of the quality control statistics is suitable to distinguish random from systematic influence on quality indicators. IEC recordings that are not specific in pathophysiologic type or are of low grade of clinical severity, are heavily dependent on systematic documentation features. We assume that peak values, such as in times of optimised documentation discipline, better reflect reality than average values because missing reporting is much more likely than false positives.
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Affiliation(s)
- U Bothner
- Department of Anaesthesiology and Intensive Care Medicine, University of Ulm, Germany
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Schwilk B, Muche R, Treiber H, Brinkmann A, Georgieff M, Bothner U. A cross-validated multifactorial index of perioperative risks in adults undergoing anaesthesia for non-cardiac surgery. Analysis of perioperative events in 26907 anaesthetic procedures. J Clin Monit Comput 1998; 14:283-94. [PMID: 9754618 DOI: 10.1023/a:1009916822005] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To develop a severity index of anaesthetic risk that predicts relevant perioperative adverse events in adults. DESIGN Prospective cross-sectional study. SETTING Department of anaesthesiology at one university hospital. PATIENTS 26907 consecutive anaesthetic procedures in patients over 15 years of age and a complete preoperative evaluation. Patients undergoing cardiac and obstetric surgery were excluded. MEASUREMENTS AND MAIN RESULTS Demographic data, preoperative health status, type of anaesthesia, operative procedures, and perioperative incidents (standardised on a national basis) were acquired by means of a computerised anaesthetic record system. Occurrence of at least one perioperative event with impact on postanaesthetic care was computed by a multivariate logistic regression model against 17 variables with different characteristics representing possible risk factors. Fourteen variables proved to be independent risk factors. The weighting of the variables was expressed in scores which added up to form a simple index for each patient. Patients without major risk factors (0-10 points) had a 0.3% risk of suffering from a relevant incident. Patients with more than 60 points had a 28.6% risk. The results were well demonstrated by cross-validation. CONCLUSIONS The index seems to reflect the risk of relevant perioperative incidents. It can be used for audit purposes. In daily routine, the index could focus our attention on patients with increased perioperative risk. However, it is limited in detecting particular constellations of factors which interact on each other with regard to perioperative risk.
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Affiliation(s)
- B Schwilk
- Department of Anaesthesiology, University of Ulm, Germany.
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Schwilk B, Bothner U, Schraag S, Georgieff M. Perioperative respiratory events in smokers and nonsmokers undergoing general anaesthesia. Acta Anaesthesiol Scand 1997; 41:348-55. [PMID: 9113178 DOI: 10.1111/j.1399-6576.1997.tb04697.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The prevalence of respiratory diseases in smokers and nonsmokers and the incidence of perioperative respiratory events (PREs) were investigated for patients undergoing general anaesthesia. The aim was to quantify well-known problems and to identify possible new associations between smoking and PREs. METHODS From July 1992 to December 1994, risk factors, demographic data, and PREs were documented by an automatically readable anaesthetic record (ARAR). PREs were used as defined by the German Society of Anaesthesiology and Intensive Care. RESULTS Of 26961 subsequent anaesthesias in adults, 7122 (26.4%) were performed in smokers with a prevalence of chronic bronchitis of 23.3% (4.8% in nonsmokers). 1573 PREs occurred in 1397 (5.2%) of all anaesthetics. 459 events concerned intubation problems and problems in technical airway management. 1114 specific respiratory events (SPREs) like re-intubation, laryngospasm, bronchospasm, aspiration, hypoventilation/hypoxaemia and others had a total incidence of 5.5% in smokers and 3.1% in nonsmokers. The relative risk (RR) of SPREs was 1.8 in all smokers, 2.3 in young (16-39 years) smokers, and 6.3 in obese young smokers. The RR of perioperative bronchospasm was 25.7 in young smokers with chronic bronchitis. CONCLUSION The impact of smoking on perioperative respiratory problems should make anaesthetists take this widespread preoperative condition seriously, particularly in young adults. The presented method of incident reporting (based on a national classification) could contribute to future research in anaesthetic epidemiology.
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Affiliation(s)
- B Schwilk
- Department of Anaesthesiology and Intensive Care, University of Ulm, Germany
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