Abstract ID: A16
Abstract Title: Regional Anesthesia Surveillance System (RASS): First results after 12 months in clinical routine
Poster Type: Either
ABSTRACT BODY
Introduction:
Most data about complications related to regional anaesthesia rely on case reports or small series and only few attempts have been made to collect data on a larger scale(1-3). These are the first experiences with a prospective Regional Anesthesia Surveillance System (RASS) at the University of Iowa Hospitals and Clinics.
Materials and Methods:
Since October 2003 surveillance using standardized definitions for diagnosis related to infections, neurologic deficits, bleeding and technical complications is performed for all continuous catheters (epidural/peripheral nerve blocks) used for anaesthesia/analgesia. The number of catheters in house is registered from the Hospital Information System (“midnight-statistic”) and complications are reported by the Acute Pain Service and classified by the RASS-coordinator.
Based on those data a complication rate (CR) is calculated using the formula: CR = (number of complications/number of catheterdays) x 1000.
Results:
100% compliance with data acquisition was reached after 3 months. The average time to complete the daily data acquisition is 14,5 minutes. The following CR-values were calculated for the year 2004, based on a total of 4099 epidural, femoral, sciatic, cervical paravertebral, interscalene, infraclavicular and axillary catheters included in the surveillance:
Type of complications: CR
Superficial epidural infection: 1,1
Bleeding epidural catheter tract: 1,1
Wet Tap: 4,5*
Wet Tap with resp/hemodynamic problems: 2.2*
Femoral catheter: Short term neurologic deficit: 8
Catheter dislocation (all types) 4.2
* per 1000 punctures
Discussion:
These preliminary data have to be reviewed in the light of small total numbers in a single institution but can already be utilized for internal benchmarking in quarterly reviews at this institution and to monitor patient safety and quality of care. The planned expansion of RASS will include all single shot procedures as well and requires the participation of multiple centers to contribute data and create an international benchmarkin database.
Conclusion:
Surveillance of complications in regional anesthesia and analgesia as a benchmarking tool
can be accomplished with minimal additional time for the practitioner using standardized definitions and a prospective registry system.
References:
1. Auroy Y, Narchi P, Messiah A, Litt L, Rouvier B, Samii K: Serious complications related to regional anesthesia: results of a prospective survey in France. Anesthesiology 1997; 87: 479-86
2. Auroy Y, Benhamou D, Bargues L, Ecoffey C, Falissard B, Mercier FJ, Bouaziz H, Samii K, Mercier F: Major complications of regional anesthesia in France: The SOS Regional Anesthesia Hotline Service. Anesthesiology 2002; 97: 1274-80
3. Moen V, Dahlgren N, Irestedt L: Severe neurological complications after central neuraxial blockades in Sweden 1990-1999. Anesthesiology 2004; 101: 950-9
ATTACHED FILES
Reg Anesth Pain Med 2004; 29(2):A16