A Scoping Review on the Incidence of Nonoperating Room Anesthesia Safety Events.

Abstract

Objectives: To determine the incidence of adverse and near-miss events in nonoperating room anesthesia (NORA); to identify study methodology, strength of findings, and knowledge gaps regarding these events.

Methods: A scoping review was performed between 2022 and 2023, surveying literature from 2006 to 2023. The included studies examined adults undergoing a NORA procedure. Excluded studies were in the intensive care unit, peripartum areas, the operating room, or pediatric only.

Results: A total of 586 records were identified using the keywords: "NORA," "non-operating room anesthesia," "anesthesia," "adverse event," and "near miss event." After screening, 58 full texts were reviewed and 12 studies were included. Five were retrospective observational, 4 were retrospective claims analyses, and 3 were surveys. Incidence rates of adverse events ranged from 0.01% to 38.6%, partially reflecting heterogeneity in event definition. Only one publication studied near-miss events: a retrospective survey of anesthesia providers. It described that near-miss events occurred more often but were reported less frequently than adverse events. A near-miss incidence rate could not be determined. Included articles were assessed using the Grading of Recommendations, Assessment, Development, and Evaluations System criteria. The overall quality was low to moderate.

Conclusions: There is limited investigation regarding NORA safety events and a lack of high-quality prospective studies. Specific areas for future investigation include: (1) standardized definition and incidence of safety events; (2) specific study of near-miss events; (3) evidence-based recommendations to optimize safety. Considering the anticipated growth of procedures and heterogenous locations, our findings strongly suggest a dedicated study of NORA-specific safety concerns.