Incidence of severe critical events in paediatric anaesthesia (APRICOT): a prospective multicentre observational study in 261 hospitals in Europe

Walid Habre, Nicola Disma, Katalin Virag, Karin Becke, Tom G. Hansen, Martin Jöhr, Brigitte Leva, Neil Morton, Petronella M. Vermeulen, Marzena Zielinska, Krisztina Boda, Francis Veyckemans, Walter Klimscha, Regina Konecny, Robert Luntzer, Ulrike Morawk-Wintersperger, Franz Neiger, Lydia Rustemeyer, Christian Breschan, Denise FreyManuela Platzer, Reinhard Germann, Joachim Oeding, Birgit Stoegermüller, Bernhard Ziegler, Philipp Brotatsch, Anton Gutmann, Gerlinde Mausser, Brigitte Messerer, Wolfgang Toller, Maria Vittinghoff, Gregor Zangl, Natascha Seidel-Ahyai, Christoph Hochhold, Ruth Kroess, Peter Paal, Steven Cnudde, Patricia Coucke, Birgit Loveniers, John Mitchell, David Kahn, Thierry Pirotte, Caroline Pregardien, Michela Bevilacqua, Nicola Disma, Leila Mameli, Giovanni Montobbio, Clelia Zanaboni, Edoardo Calderini, Simona Neri, APRICOT Group of the European Society of Anaesthesiology Clinical Trial Network, APRICOT Group of the European Society of Anaesthesiology Clinical Trial Network

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Abstract

Background Little is known about the incidence of severe critical events in children undergoing general anaesthesia in Europe. We aimed to identify the incidence, nature, and outcome of severe critical events in children undergoing anaesthesia, and the associated potential risk factors. Methods The APRICOT study was a prospective observational multicentre cohort study of children from birth to 15 years of age undergoing elective or urgent anaesthesia for diagnostic or surgical procedures. Children were eligible for inclusion during a 2-week period determined prospectively by each centre. There were 261 participating centres across 33 European countries. The primary endpoint was the occurence of perioperative severe critical events requiring immediate intervention. A severe critical event was defined as the occurrence of respiratory, cardiac, allergic, or neurological complications requiring immediate intervention and that led (or could have led) to major disability or death. This study is registered with ClinicalTrials.gov, number NCT01878760. Findings Between April 1, 2014, and Jan 31, 2015, 31 127 anaesthetic procedures in 30 874 children with a mean age of 6·35 years (SD 4·50) were included. The incidence of perioperative severe critical events was 5·2% (95% CI 5·0–5·5) with an incidence of respiratory critical events of 3·1% (2·9–3·3). Cardiovascular instability occurred in 1·9% (1·7–2·1), with an immediate poor outcome in 5·4% (3·7–7·5) of these cases. The all-cause 30-day in-hospital mortality rate was 10 in 10 000. This was independent of type of anaesthesia. Age (relative risk 0·88, 95% CI 0·86–0·90; p<0·0001), medical history, and physical condition (1·60, 1·40–1·82; p<0·0001) were the major risk factors for a serious critical event. Multivariate analysis revealed evidence for the beneficial effect of years of experience of the most senior anaesthesia team member (0·99, 0·981–0·997; p<0·0048 for respiratory critical events, and 0·98, 0·97–0·99; p=0·0039 for cardiovascular critical events), rather than the type of health institution or providers. Interpretation This study highlights a relatively high rate of severe critical events during the anaesthesia management of children for surgical or diagnostic procedures in Europe, and a large variability in the practice of paediatric anaesthesia. These findings are substantial enough to warrant attention from national, regional, and specialist societies to target education of anaesthesiologists and their teams and implement strategies for quality improvement in paediatric anaesthesia. Funding European Society of Anaesthesiology.

Original languageEnglish
Pages (from-to)412-425
Number of pages14
JournalThe Lancet Respiratory Medicine
Volume5
Issue number5
DOIs
Publication statusPublished - May 1 2017

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Multicenter Studies
Observational Studies
Anesthesia
Pediatrics
Incidence
Anesthesiology
Quality Improvement
Hospital Mortality
General Anesthesia
Anesthetics
Cohort Studies
Multivariate Analysis
Parturition
Education
Mortality
Health

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Habre, W., Disma, N., Virag, K., Becke, K., Hansen, T. G., Jöhr, M., ... APRICOT Group of the European Society of Anaesthesiology Clinical Trial Network (2017). Incidence of severe critical events in paediatric anaesthesia (APRICOT): a prospective multicentre observational study in 261 hospitals in Europe. The Lancet Respiratory Medicine, 5(5), 412-425. https://doi.org/10.1016/S2213-2600(17)30116-9

Incidence of severe critical events in paediatric anaesthesia (APRICOT) : a prospective multicentre observational study in 261 hospitals in Europe. / Habre, Walid; Disma, Nicola; Virag, Katalin; Becke, Karin; Hansen, Tom G.; Jöhr, Martin; Leva, Brigitte; Morton, Neil; Vermeulen, Petronella M.; Zielinska, Marzena; Boda, Krisztina; Veyckemans, Francis; Klimscha, Walter; Konecny, Regina; Luntzer, Robert; Morawk-Wintersperger, Ulrike; Neiger, Franz; Rustemeyer, Lydia; Breschan, Christian; Frey, Denise; Platzer, Manuela; Germann, Reinhard; Oeding, Joachim; Stoegermüller, Birgit; Ziegler, Bernhard; Brotatsch, Philipp; Gutmann, Anton; Mausser, Gerlinde; Messerer, Brigitte; Toller, Wolfgang; Vittinghoff, Maria; Zangl, Gregor; Seidel-Ahyai, Natascha; Hochhold, Christoph; Kroess, Ruth; Paal, Peter; Cnudde, Steven; Coucke, Patricia; Loveniers, Birgit; Mitchell, John; Kahn, David; Pirotte, Thierry; Pregardien, Caroline; Bevilacqua, Michela; Disma, Nicola; Mameli, Leila; Montobbio, Giovanni; Zanaboni, Clelia; Calderini, Edoardo; Neri, Simona; APRICOT Group of the European Society of Anaesthesiology Clinical Trial Network; APRICOT Group of the European Society of Anaesthesiology Clinical Trial Network.

In: The Lancet Respiratory Medicine, Vol. 5, No. 5, 01.05.2017, p. 412-425.

Research output: Contribution to journalArticle

Habre, W, Disma, N, Virag, K, Becke, K, Hansen, TG, Jöhr, M, Leva, B, Morton, N, Vermeulen, PM, Zielinska, M, Boda, K, Veyckemans, F, Klimscha, W, Konecny, R, Luntzer, R, Morawk-Wintersperger, U, Neiger, F, Rustemeyer, L, Breschan, C, Frey, D, Platzer, M, Germann, R, Oeding, J, Stoegermüller, B, Ziegler, B, Brotatsch, P, Gutmann, A, Mausser, G, Messerer, B, Toller, W, Vittinghoff, M, Zangl, G, Seidel-Ahyai, N, Hochhold, C, Kroess, R, Paal, P, Cnudde, S, Coucke, P, Loveniers, B, Mitchell, J, Kahn, D, Pirotte, T, Pregardien, C, Bevilacqua, M, Disma, N, Mameli, L, Montobbio, G, Zanaboni, C, Calderini, E, Neri, S, APRICOT Group of the European Society of Anaesthesiology Clinical Trial Network & APRICOT Group of the European Society of Anaesthesiology Clinical Trial Network 2017, 'Incidence of severe critical events in paediatric anaesthesia (APRICOT): a prospective multicentre observational study in 261 hospitals in Europe', The Lancet Respiratory Medicine, vol. 5, no. 5, pp. 412-425. https://doi.org/10.1016/S2213-2600(17)30116-9
Habre, Walid ; Disma, Nicola ; Virag, Katalin ; Becke, Karin ; Hansen, Tom G. ; Jöhr, Martin ; Leva, Brigitte ; Morton, Neil ; Vermeulen, Petronella M. ; Zielinska, Marzena ; Boda, Krisztina ; Veyckemans, Francis ; Klimscha, Walter ; Konecny, Regina ; Luntzer, Robert ; Morawk-Wintersperger, Ulrike ; Neiger, Franz ; Rustemeyer, Lydia ; Breschan, Christian ; Frey, Denise ; Platzer, Manuela ; Germann, Reinhard ; Oeding, Joachim ; Stoegermüller, Birgit ; Ziegler, Bernhard ; Brotatsch, Philipp ; Gutmann, Anton ; Mausser, Gerlinde ; Messerer, Brigitte ; Toller, Wolfgang ; Vittinghoff, Maria ; Zangl, Gregor ; Seidel-Ahyai, Natascha ; Hochhold, Christoph ; Kroess, Ruth ; Paal, Peter ; Cnudde, Steven ; Coucke, Patricia ; Loveniers, Birgit ; Mitchell, John ; Kahn, David ; Pirotte, Thierry ; Pregardien, Caroline ; Bevilacqua, Michela ; Disma, Nicola ; Mameli, Leila ; Montobbio, Giovanni ; Zanaboni, Clelia ; Calderini, Edoardo ; Neri, Simona ; APRICOT Group of the European Society of Anaesthesiology Clinical Trial Network ; APRICOT Group of the European Society of Anaesthesiology Clinical Trial Network. / Incidence of severe critical events in paediatric anaesthesia (APRICOT) : a prospective multicentre observational study in 261 hospitals in Europe. In: The Lancet Respiratory Medicine. 2017 ; Vol. 5, No. 5. pp. 412-425.
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abstract = "Background Little is known about the incidence of severe critical events in children undergoing general anaesthesia in Europe. We aimed to identify the incidence, nature, and outcome of severe critical events in children undergoing anaesthesia, and the associated potential risk factors. Methods The APRICOT study was a prospective observational multicentre cohort study of children from birth to 15 years of age undergoing elective or urgent anaesthesia for diagnostic or surgical procedures. Children were eligible for inclusion during a 2-week period determined prospectively by each centre. There were 261 participating centres across 33 European countries. The primary endpoint was the occurence of perioperative severe critical events requiring immediate intervention. A severe critical event was defined as the occurrence of respiratory, cardiac, allergic, or neurological complications requiring immediate intervention and that led (or could have led) to major disability or death. This study is registered with ClinicalTrials.gov, number NCT01878760. Findings Between April 1, 2014, and Jan 31, 2015, 31 127 anaesthetic procedures in 30 874 children with a mean age of 6·35 years (SD 4·50) were included. The incidence of perioperative severe critical events was 5·2{\%} (95{\%} CI 5·0–5·5) with an incidence of respiratory critical events of 3·1{\%} (2·9–3·3). Cardiovascular instability occurred in 1·9{\%} (1·7–2·1), with an immediate poor outcome in 5·4{\%} (3·7–7·5) of these cases. The all-cause 30-day in-hospital mortality rate was 10 in 10 000. This was independent of type of anaesthesia. Age (relative risk 0·88, 95{\%} CI 0·86–0·90; p<0·0001), medical history, and physical condition (1·60, 1·40–1·82; p<0·0001) were the major risk factors for a serious critical event. Multivariate analysis revealed evidence for the beneficial effect of years of experience of the most senior anaesthesia team member (0·99, 0·981–0·997; p<0·0048 for respiratory critical events, and 0·98, 0·97–0·99; p=0·0039 for cardiovascular critical events), rather than the type of health institution or providers. Interpretation This study highlights a relatively high rate of severe critical events during the anaesthesia management of children for surgical or diagnostic procedures in Europe, and a large variability in the practice of paediatric anaesthesia. These findings are substantial enough to warrant attention from national, regional, and specialist societies to target education of anaesthesiologists and their teams and implement strategies for quality improvement in paediatric anaesthesia. Funding European Society of Anaesthesiology.",
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T1 - Incidence of severe critical events in paediatric anaesthesia (APRICOT)

T2 - a prospective multicentre observational study in 261 hospitals in Europe

AU - Habre, Walid

AU - Disma, Nicola

AU - Virag, Katalin

AU - Becke, Karin

AU - Hansen, Tom G.

AU - Jöhr, Martin

AU - Leva, Brigitte

AU - Morton, Neil

AU - Vermeulen, Petronella M.

AU - Zielinska, Marzena

AU - Boda, Krisztina

AU - Veyckemans, Francis

AU - Klimscha, Walter

AU - Konecny, Regina

AU - Luntzer, Robert

AU - Morawk-Wintersperger, Ulrike

AU - Neiger, Franz

AU - Rustemeyer, Lydia

AU - Breschan, Christian

AU - Frey, Denise

AU - Platzer, Manuela

AU - Germann, Reinhard

AU - Oeding, Joachim

AU - Stoegermüller, Birgit

AU - Ziegler, Bernhard

AU - Brotatsch, Philipp

AU - Gutmann, Anton

AU - Mausser, Gerlinde

AU - Messerer, Brigitte

AU - Toller, Wolfgang

AU - Vittinghoff, Maria

AU - Zangl, Gregor

AU - Seidel-Ahyai, Natascha

AU - Hochhold, Christoph

AU - Kroess, Ruth

AU - Paal, Peter

AU - Cnudde, Steven

AU - Coucke, Patricia

AU - Loveniers, Birgit

AU - Mitchell, John

AU - Kahn, David

AU - Pirotte, Thierry

AU - Pregardien, Caroline

AU - Bevilacqua, Michela

AU - Disma, Nicola

AU - Mameli, Leila

AU - Montobbio, Giovanni

AU - Zanaboni, Clelia

AU - Calderini, Edoardo

AU - Neri, Simona

AU - APRICOT Group of the European Society of Anaesthesiology Clinical Trial Network

AU - APRICOT Group of the European Society of Anaesthesiology Clinical Trial Network

PY - 2017/5/1

Y1 - 2017/5/1

N2 - Background Little is known about the incidence of severe critical events in children undergoing general anaesthesia in Europe. We aimed to identify the incidence, nature, and outcome of severe critical events in children undergoing anaesthesia, and the associated potential risk factors. Methods The APRICOT study was a prospective observational multicentre cohort study of children from birth to 15 years of age undergoing elective or urgent anaesthesia for diagnostic or surgical procedures. Children were eligible for inclusion during a 2-week period determined prospectively by each centre. There were 261 participating centres across 33 European countries. The primary endpoint was the occurence of perioperative severe critical events requiring immediate intervention. A severe critical event was defined as the occurrence of respiratory, cardiac, allergic, or neurological complications requiring immediate intervention and that led (or could have led) to major disability or death. This study is registered with ClinicalTrials.gov, number NCT01878760. Findings Between April 1, 2014, and Jan 31, 2015, 31 127 anaesthetic procedures in 30 874 children with a mean age of 6·35 years (SD 4·50) were included. The incidence of perioperative severe critical events was 5·2% (95% CI 5·0–5·5) with an incidence of respiratory critical events of 3·1% (2·9–3·3). Cardiovascular instability occurred in 1·9% (1·7–2·1), with an immediate poor outcome in 5·4% (3·7–7·5) of these cases. The all-cause 30-day in-hospital mortality rate was 10 in 10 000. This was independent of type of anaesthesia. Age (relative risk 0·88, 95% CI 0·86–0·90; p<0·0001), medical history, and physical condition (1·60, 1·40–1·82; p<0·0001) were the major risk factors for a serious critical event. Multivariate analysis revealed evidence for the beneficial effect of years of experience of the most senior anaesthesia team member (0·99, 0·981–0·997; p<0·0048 for respiratory critical events, and 0·98, 0·97–0·99; p=0·0039 for cardiovascular critical events), rather than the type of health institution or providers. Interpretation This study highlights a relatively high rate of severe critical events during the anaesthesia management of children for surgical or diagnostic procedures in Europe, and a large variability in the practice of paediatric anaesthesia. These findings are substantial enough to warrant attention from national, regional, and specialist societies to target education of anaesthesiologists and their teams and implement strategies for quality improvement in paediatric anaesthesia. Funding European Society of Anaesthesiology.

AB - Background Little is known about the incidence of severe critical events in children undergoing general anaesthesia in Europe. We aimed to identify the incidence, nature, and outcome of severe critical events in children undergoing anaesthesia, and the associated potential risk factors. Methods The APRICOT study was a prospective observational multicentre cohort study of children from birth to 15 years of age undergoing elective or urgent anaesthesia for diagnostic or surgical procedures. Children were eligible for inclusion during a 2-week period determined prospectively by each centre. There were 261 participating centres across 33 European countries. The primary endpoint was the occurence of perioperative severe critical events requiring immediate intervention. A severe critical event was defined as the occurrence of respiratory, cardiac, allergic, or neurological complications requiring immediate intervention and that led (or could have led) to major disability or death. This study is registered with ClinicalTrials.gov, number NCT01878760. Findings Between April 1, 2014, and Jan 31, 2015, 31 127 anaesthetic procedures in 30 874 children with a mean age of 6·35 years (SD 4·50) were included. The incidence of perioperative severe critical events was 5·2% (95% CI 5·0–5·5) with an incidence of respiratory critical events of 3·1% (2·9–3·3). Cardiovascular instability occurred in 1·9% (1·7–2·1), with an immediate poor outcome in 5·4% (3·7–7·5) of these cases. The all-cause 30-day in-hospital mortality rate was 10 in 10 000. This was independent of type of anaesthesia. Age (relative risk 0·88, 95% CI 0·86–0·90; p<0·0001), medical history, and physical condition (1·60, 1·40–1·82; p<0·0001) were the major risk factors for a serious critical event. Multivariate analysis revealed evidence for the beneficial effect of years of experience of the most senior anaesthesia team member (0·99, 0·981–0·997; p<0·0048 for respiratory critical events, and 0·98, 0·97–0·99; p=0·0039 for cardiovascular critical events), rather than the type of health institution or providers. Interpretation This study highlights a relatively high rate of severe critical events during the anaesthesia management of children for surgical or diagnostic procedures in Europe, and a large variability in the practice of paediatric anaesthesia. These findings are substantial enough to warrant attention from national, regional, and specialist societies to target education of anaesthesiologists and their teams and implement strategies for quality improvement in paediatric anaesthesia. Funding European Society of Anaesthesiology.

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