The thai anesthesia incident monitoring study (thai aims): An analysis of perioperative complication in geriatric patients

Abstract

Background: The present study was a part of the multi-centered study of model of Anesthesia related adverse events in Thailand by incident report. (The Thai Anesthesia Incident Monitoring Study or Thai AIMS). The objective of the present study was to identity and analyze anesthesia incident in geriatric patients in order to find out the frequency distribution, clinical courses, management of incidents and investigation of model appropriate for possible corrective strategies. Material and Method: This study was a prospective descriptive multicentered study conducted between January 1, 2007 and June 30, 2007. Incident reports from 51 hospital across Thailand were sent to data management unit on anonymous and voluntary basis. The authors extracted relevant data from the incident reports on geriatric patients (age 65 or more). The cases were reviewed by 3 anesthesiologists. Any disagreement was discussed and judged to achieve a consensus. Descriptive statistics was used. Results: Among 407 incident reports and 559 incidents, there were more male (52.8%) than female (46.7%) patients with ASA PS 2,3,4 and 5 = 38.6%, 42.8%, 14.5% and 4.2% respectively. Surgical specialties that posed high risk of incidents were general, orthopedic, neurological, urologic and otorhiolaryngological surgery. Common places where incidents occurred were operating room (57.1%), ward (30.9%) and recovery room (12.0%). Common occurred incidents were arrhythmia needing treatment (30.0%), death within 24 hr. (24.6%), desaturation (21.9%), cardiac arrest (16.2%) and reintubation (16.0%). The causes of the incidents were mostly attributed from patients underlying diseases and conditions. Most common outcomes were major physiologic changes with 26.5% fatal outcome at 7 days. The most common contributing factor was human factor (inappropriate decision and inexperience). Vigilance and having more experience could be the minimizing factors. Conclusion: Incidents in geriatric patients were similar to all age group patients with a higher incidents in death within 24 hr. The outcome were more serious resulting in 26.5% fatal outcome at 7 days. Quality assurance activity, clinical practice guidelines and improved supervision were suggested corrective strategies.