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Research published in the December 2010 issue of Anesthesiology describes the development of a predictive index to determine which patients are most at risk to develop postoperative pulmonary complications (PPCs). The issue also includes research on the impact of a 2006 safety initiative on patient-controlled analgesia (PCA).
Predictive Risk Factors for PPCs
PPCs account for a substantial proportion of risk related to surgery and anesthesia, and are a major cause of postoperative morbidity, mortality and longer hospital stays. A recent study was the first to represent an entire country’s population to predict which patients were at the highest risk of suffering PPCs.
The study analyzed a random sample of more than 2,400 surgical patients from 59 participating clinics and hospitals in Catalonia, Spain. Researchers identified seven independent risk factors for the predictive index: low preoperative arterial oxygen saturation, acute respiratory infection (including flu) during the previous month, age, preoperative anemia, upper-abdominal or intrathoracic surgery, current surgical duration (≥2 hours) and whether the surgery was an emergency, according to lead study author Jaume Canet, M.D., Ph.D.
“Findings revealed that smoking more than a pack a day for 40 years triples the risk of PPCs and increases the risk of death by five times,” said Dr. Canet, Head of Anesthesiology and Critical Care Medicine at Hospital Universitari Germans Trias i Pujol. “We also found that six out of 10 Catalan patients undergoing surgery were overweight or obese.”
PCA Safety Improvements
PCA is a way pain medication, typically morphine, is administered intravenously through a programmable pump, with the dosing frequency controlled by the patient. In the past, PCA pumps had issues with errors during the programming process, requiring a safety intervention by a multidisciplinary safety panel. Updates to improve safety included new PCA pumps, preprinted physician orders, mandatory checks of the settings and nurse education.
A new study examined critical incident reports from 2002-2009 that spanned three tertiary care hospitals to determine whether the safety intervention reduced the number of adverse drug events related to PCA. Findings showed a total of 25,198 patients were treated with PCA. Among these patients there were 62 errors, with 21 errors involving pump programming. Programming the wrong drug concentration and the improper setup of I.V. tubing were the most common errors, typically resulting in a drug overdosage.
According to lead study author James E. Paul, M.D., M.Sc., F.R.C.P.C., the incidence of PCA errors was less than 1 percent after the safety intervention. “We found that the safety intervention significantly reduced the chance of all PCA errors. While it is accepted that to err is human, it is important for anesthesiologists to continue their efforts in addressing system issues to further minimize the chance of error,” said Dr. Paul, Associate Clinical Professor at McMaster University, Hamilton, Ontario.
For more information, visit the Anesthesiology website at www.anesthesiology.org.
