NAP7 – what's the point?

Ward and Illif ask whether there have been too many papers on the 7th UK National Audit Project (NAP7) and whether the “primary purpose” of the project has been lost [1]. NAP7 was a massive project during a pandemic. It is unsurprising that peri-operative cardiac arrest and its contributing factors have generated a large amount of information given this is the final common pathway for serious complications of anaesthesia and surgery [2]. These include those studied in previous NAPs (e.g. airway complications, anaphylaxis) [2]. Of note, NAP7 reported on more cases than NAPs 3–6 combined [3].

We have a duty to share our findings as widely as possible; for our patients, their families, our stakeholders and the thousands of anaesthetists in the UK and Ireland who contributed data to NAP7. In addition to providing new information about complications and for different patients or subspecialties (e.g. children [4], obstetrics [5]), secondary outputs have been driven by our stakeholders. NAP7 has provided novel and up-to-date information in several areas that are important or contentious for anaesthetists and our patients (e.g. impact of COVID-19 [6], use of monitoring [7], the independent sector [8], anaesthesia associates [9] and wellbeing [3]).

At all stages, we made efforts to minimise the number of chapters and the length of these to improve accessibility. An illustration of this is the NAP7 ‘airway and breathing’ chapter and paper [10] that reports on 113 cases and runs to 12 pages compared with NAP4 which included 133 anaesthesia airway cases and runs to 216 pages. The division of the report into discrete short chapters specifically enables and encourages readers to focus on areas most relevant to their areas of practice.

Many of the report chapters have been subsequently published as papers in Anaesthesia, often with additional data and discussion. No project is complete until it is disseminated, and it was, therefore, an intentional strategy to improve visibility of the project by publishing key topic chapters as papers, after full peer review. This further enabled dissemination through podcasts and social media. We judge this a success and thank Anaesthesia and its editors.

The prime purpose of the NAPs is “through national effort to provide detailed numerical and case-based analysis of risk and complications of anaesthesia and surgery, to make these data available to patients and clinicians and in so doing so facilitate better communication and decision making and drive changes that improve safety”. We believe all the findings and recommendations of NAP7 will help make anaesthesia safer and are important for anaesthetists and their patients – we have no regrets about sharing them as widely as possible.

Finally, we thank Ward and Illif for applauding the thoroughness and dissemination of the NAP7 project and the infographic [1]. In answer to what they and colleagues should read given the large number of outputs, we encourage every anaesthetist to read the main papers published in Anaesthesia in November 2023. We also recommend reading the summary chapters in the report [3], which include key findings and 20 main recommendations aimed at making anaesthesia care safer. While few will read the whole report, we encourage anaesthetists to read those papers and chapters that focus on their interests. We hope this stimulates a deeper dive into the report which includes other key chapters on risk, cardiac arrest in low-risk patients, good practice and many others.