Anesthesiologist- and System-Related Risk Factors for Risk-Adjusted Pediatric Anesthesia-Related XXXX .

@entity1 @entity1167
BACKGROUND: Pediatric anesthesia-related @entity1167 (ARCA) is an uncommon but potentially preventable adverse event. @entity1 and @entity1 with more severe underlying disease are at highest risk. We aimed to identify system- and anesthesiologist-related risk factors for ARCA. METHODS: We analyzed a prospectively collected @entity1 cohort data set of anesthetics administered from 2000 to 2011 to @entity1 at a large tertiary pediatric hospital. Pre-procedure systemic disease level was characterized by ASA physical status (ASA-PS). Two reviewers independently reviewed cardiac arrests and categorized their anesthesia relatedness. Factors associated with ARCA in the univariate analyses were identified for reevaluation after adjustment for @entity1 age and ASA-PS. RESULTS: @entity1167 occurred in 142 of 276,209 anesthetics (incidence 5.1/10,000 anesthetics); 72 (2.6/10,000 anesthetics) were classified as anesthesia-related. In the univariate analyses, risk of ARCA was much higher in cardiac @entity1 and for anesthesiologists with lower annual caseload and/or fewer annual days delivering anesthetics (all P < 0.001). Anesthesiologists with the highest academic rank and years of experience also had higher odds of ARCA (P = 0.02). After risk adjustment for ASA-PS >= III and age  <=6 months, however, the association with lower annual days delivering anesthetics remained (P = 0.03), but the other factors were no longer significant. CONCLUSIONS: Case-mix explained most associations between higher risk of pediatric ARCA and anesthesiologist-related variables at our institution, but the association with fewer annual days delivering anesthetics remained. Our findings highlight the need for rigorous adjustment for @entity1 risk factors in anesthesia @entity1 safety studies.
