Anesthesiologist-related factors associated with risk-adjusted pediatric anesthesia-related cardiopulmonary arrest: a retrospective two level analysis.

Background: Pediatric anesthesia-related cardiac arrest is an uncommon but catastrophic adverse event which has been, in a previous study, associated with anesthesiologist-related factors such as number of days per year providing pediatric anesthesia. We aimed to replicate this and assess other anesthesiologist-related risk factors for anesthesia-related cardiac arrest after adjusting for known underlying risk factors present in the case mix.

Methods: We analyzed a large retrospectively collected patient cohort of anesthetics administered from 2006 to 2016 to children at a tertiary pediatric hospital. Three reviewers independently reviewed cardiac arrests and categorized whether they appeared to be related to anesthesia care. Anesthesiologist-related factors including academic rank, experience, recent case mix, and days per year delivering pediatric anesthesia were assessed for association with anesthesia-related cardiac arrest after adjustment for underlying case mix.

Results: Cardiac arrest occurred in 240 of 109 775 anesthetics (incidence 22/10 000 anesthetics); 82 (7/10 000 anesthetics) were classified as anesthesia-related. In univariable analyses, anesthesia-related cardiac arrest was associated with age, (infants ≤180 days, p < .001) American Society of Anesthesiologists Physical Status, (>2, p < .001) American Society of Anesthesiologists Physical Status Emergency, (p = .0035) cardiac surgery, (p < .001) operating room location, (p = .0066) and resident/fellow supervision, (p = .009) but none of the anesthesiologist factors. Even after adjusting for age and American Society of Anesthesiologist Status, none of the anesthesiologist factors were associated with anesthesia-related cardiac arrest.

Conclusions: Case mix explained all associations between higher risk of pediatric anesthesia-related cardiac arrest and anesthesiologist-related variables at our institution.