title: Advanced regional anesthesia morbidity and mortality grading system: regional anesthesia outcomes reporting (ROAR).
abstract: OBJECTIVE
  A regional anesthesia complication grading system (regional anesthesia outcomes reporting [ROAR]) was developed and applied to 1,213 consecutive patients over a 14-month period. The goal of the project was the creation of a system to standardize complication reporting in the regional anesthesia literature.
  
  
  METHODS
  Patient demographics, status as a war casualty, regional block procedure-specific details, and complication grade were entered into an Internet-based, encrypted Department of Defense database. Regional anesthesia complications were later graded and subcategorized depending on what phase of the block the procedural adverse event took place.
  
  
  RESULTS
  One thousand ninety-eight (90.5%) patients had neither regional anesthesia associated technical difficulties or more severe complications. Of a total of 147 cases with adverse events among 115 patients (1.3 per patient), the majority (63.3%, 93/147) were low-grade complications resulting in no significant morbidity. The most common complications resulting in patient morbidity were failed block requiring catheter removal and/or supplemental block (35.4%, 17/48). High grade complications represented only 4.1% (6/147) of all peri-procedural morbidity. These complications included pneumothorax requiring tube thoracostomy, transient laryngeal nerve dysfunction, and cancellation of planned operation after peripheral nerve block or catheter placement.
  
  
  CONCLUSIONS
  The value of the ROAR system is that it identifies important issues in risk management in regional anesthesia, thereby providing opportunities for further investigation and clinical practice refinement. Furthermore, it provides for a common language when reporting outcomes in the regional anesthesia literature. Use of the ROAR system will provide consistency in outcomes reporting and facilitate comparisons between methods and procedures.
authors.affiliation: Army Regional Anesthesia and Pain Management Initiative, Anesthesia and Operative Service, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA. chester.buckenmaier@amedd.army.mil
authors.forename: Chester C
authors.initials: CC
authors.lastname: Buckenmaier
authors.forename: Scott M
authors.initials: SM
authors.lastname: Croll
authors.forename: Cynthia H
authors.initials: CH
authors.lastname: Shields
authors.forename: Sean M
authors.initials: SM
authors.lastname: Shockey
authors.forename: Lisa L
authors.initials: LL
authors.lastname: Bleckner
authors.forename: Greg
authors.initials: G
authors.lastname: Malone
authors.forename: Anthony
authors.initials: A
authors.lastname: Plunkett
authors.forename: Geselle M
authors.initials: GM
authors.lastname: McKnight
authors.forename: Kyung H
authors.initials: KH
authors.lastname: Kwon
authors.forename: Richard
authors.initials: R
authors.lastname: Joltes
authors.forename: Alexander
authors.initials: A
authors.lastname: Stojadinovic
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000765:Anesthesia, Conduction / Q000009:adverse effects* / Q000401:mortality*; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects / Q000401:mortality; D016017:Odds Ratio; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014857:Warfare; D014947:Wounds and Injuries / Q000628:therapy; D055815:Young Adult