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A4080
October 14, 2014
3:00 PM - 4:30 PM
Room Room 244
Obstetric Outcomes Data from the Anesthesia Quality Institute National Anesthesia Clinical Outcomes Registry
Samir R. Jani, M.D., M.P.H., Richard P. Dutton, M.D., M.B.A., Dominique Y. Moffitt, M.D., Richard D. Urman, M.D., M.B.A.
Beth Israel Deaconess, Boston, Massachusetts, United States
Practicing anesthesiology on the labor and delivery ward is a high risk proposal.1 While it is a staple of clinical practice, there is minimal information in the literature regarding adverse events in this setting. Obstetric anesthesiology case data was isolated and reviewed for patient and anesthesia characteristics in addition to outcomes reported to NACOR.

Methods

NACOR is the largest anesthesia database. Practices voluntarily submit information to NACOR which is automatically harvested from clinical programs such as billing records and anesthesia information management systems.2 While data is stored centrally at AQI, uploading and transmitting it is facility dependent and occurs in quarterly increments. Facilities may submit material at variable times. Additionally, each facility may not track all data allowing for inconstant denominators for each outcome. As of December 2013, approximately 218 practices nationwide submit data culminating in over 13.5 million anesthetic cases from 2010 to 2013. Of these, 474,662 (3.5%) were identified as obstetric anesthesiology cases.

Results: See Table # 1 and 2

Discussion

Obstetric anesthesia is a prominent subspecialty in anesthesiology yet there is minimal outcome data. We aimed to provide a glimpse into patient characteristics, type of anesthesia delivered, and the adverse events experienced by these patients.

Regarding age, the findings are as expected except the category for patients under one year old. This is peculiar and could represent an error in reporting or possibly new-born babies who received treatment immediately after birth. They would have been grouped in with obstetric cases because of location. Greater than 32,000 patients are classified as ASA III-V constituting approximately 6.89% of the patients. Neuraxial anesthesia is the most common type of anesthesia utilized. Neuraxial techniques were used over 88% when examining all cases with type of anesthesia data.

Fortunately the occurrence of adverse events is low according to the NACOR data. Medication errors are the majority of the events reported; the 2,223 incidences are from 80,093 cases that tracked and submitted data regarding this outcome (2.78%). This includes incorrect dosages, expired medication administration, and administrating an unintended medication among other issues. A common concern for any practicing obstetric anesthesiologist is a “wet-tap” during epidural placement. This or any post-dural puncture headache is reported 161 times out of 83,786 (0.19%) cases tracking this outcome.

References:

1.

J Sudharma Ranasingh et al. Current Status of Obstetric Anesthesia: Improving Satisfaction and Safety. Indian J Anaesth. Oct 2009; 53(5): 608-617.

2.

Dutton R. Committee Update: Anesthesia Quality Institute. ASA Newsletter. Feb 2014; 78 (2).

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