# Assessing Perioperative Anesthesia Safety in Urological Surgeries: A Comprehensive Study of Critical Incidents

## TL;DR

This study examines preventable anesthesia-related incidents during urological surgeries, finding that most are due to human errors and could be avoided with better training and protocols.

## Contribution

The study provides a comprehensive analysis of critical incidents in urological anesthesia, emphasizing human factors and preventability in a diverse patient population.

## Key findings

- 9.83% of patients experienced critical incidents, with cardiovascular issues being the most common.
- Human factors like lack of skill and vigilance were the leading causes of incidents.
- Most incidents were preventable with existing protocols, especially during anesthesia induction.

## Abstract

Background

Anesthesia-related critical incidents are significant causes of preventable harm during surgeries, particularly in specialized fields such as urology as they pose unique challenges, including advanced patient age, comorbidities, and complex procedures, which heighten anesthesia-related risks. These incidents are influenced by human errors, patient factors, and procedural complexity. Despite global advancements in safety protocols, there remains a need for standardized reporting and analysis of such incidents, especially in low/middle-income countries (LMICs).

Methods

A prospective and retrospective observational study was conducted from 2019 to 2022. Data was collected from the anesthesia database and perioperative records of 2,541 patients who underwent urological surgeries. Two hundred forty-one (9.48%) patients experienced critical incidents. Data included patient demographics such as age and gender, comorbidities, surgery details, and the timing and recognition of incidents. Incidents were divided into cardiovascular, respiratory, airway, central nervous system (CNS), and miscellaneous categories. A root cause analysis identified human and systemic factors.

Results

The incidence rate of critical incidents was 9.83%. The most common age group was 31-40 years (20.75%), and 71.36% of patients were men. Most incidents occurred in American Society of Anesthesiologists (ASA) Grade I patients (58.09%) and during the induction phase of anesthesia (41.49%). Cardiovascular incidents were the most frequent (23.24%), followed by airway issues (12.86%). Human factors, such as the lack of skill (43.98%), vigilance (22.41%), and judgment (16.18%), were the leading causes. Surgical position, especially lithotomy, was significantly associated with incidents (p<0.0001), and a significant association between the time to recognition of an incident and the mode of recognition of the incident was also found (p<0.0001). Notably, 98.75% of incidents were deemed preventable with existing protocols.

Conclusion

Human factors, especially the lack of skill, vigilance, and judgment, emerged as the primary contributors to critical incidents in anesthetic procedures. Emphasizing improved training, vigilance during induction, and attention to patient positioning can enhance patient safety. Most incidents were preventable, highlighting the need for better reporting and preventive protocols.