title: Anesthesiologist- and System-Related Risk Factors for Risk-Adjusted Pediatric Anesthesia-Related Cardiac Arrest.
abstract: BACKGROUND
  Pediatric anesthesia-related cardiac arrest (ARCA) is an uncommon but potentially preventable adverse event. Infants and children 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 patient cohort data set of anesthetics administered from 2000 to 2011 to children 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 patient age and ASA-PS.
  
  
  RESULTS
  Cardiac arrest 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 patients 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 patient risk factors in anesthesia patient safety studies.
authors.affiliation: From the *Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts; and †Center for Patient Safety and Quality Research, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Steven E
authors.initials: SE
authors.lastname: Zgleszewski
authors.forename: Dionne A
authors.initials: DA
authors.lastname: Graham
authors.forename: Paul R
authors.initials: PR
authors.lastname: Hickey
authors.forename: Robert M
authors.initials: RM
authors.lastname: Brustowicz
authors.forename: Kirsten C
authors.initials: KC
authors.lastname: Odegard
authors.forename: Rahul
authors.initials: R
authors.lastname: Koka
authors.forename: Christian
authors.initials: C
authors.lastname: Seefelder
authors.forename: Andres T
authors.initials: AT
authors.lastname: Navedo
authors.forename: Adrienne G
authors.initials: AG
authors.lastname: Randolph
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000758:Anesthesia / Q000009:adverse effects*; D000776:Anesthesiology / Q000193:education; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D006323:Heart Arrest / Q000139:chemically induced* / Q000453:epidemiology*; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D061214:Patient Safety; D010372:Pediatrics; D011446:Prospective Studies; D020379:Risk Adjustment; D012307:Risk Factors