Airway management complications: an audit from a large tertiary hospital

BACKGROUND The 4th National Audit Project of the Royal College of Anaesthetists reported an incidence of major airway complications of 1 in 22 000 general anaesthetics. A decade later, the 7th National Audit Project reported on peri-operative cardiac arrests; a third of these were cardiovascular, and a quarter were airway related. OBJECTIVE To assess airway management complications throughout our hospital and identify specific areas for improvement. DESIGN Single-centre prospective observational audit from October to December 2023. Data was collected using a QR code linked to a web collection tool, Google Form. SETTINGS A large academic adult tertiary referral centre. PARTICIPANTS Patients who required airway management, elective and emergency, across the hospital, including our main operating theatres, remote anaesthesia sites, postanaesthetic care unit, intensive care unit, emergency department and wards. MAIN OUTCOME The incidence of complications of airway management. RESULTS There were 63 airway complications recorded in 48 patients, an overall incidence of 3.4%. Airway complications were noted to have a higher incidence in emergency compared to elective airway management (5.4 vs. 2.2%, P = 0.002). Locations outside the operating theatres (emergency department, intensive care unit and wards) had a higher complication rate compared to theatre and remote anaesthesia sites (16.2 vs. 2.5%, P < 0.001). Patients whose airway was managed on the wards were twice as likely to experience a complication compared to those in our emergency department and three times as likely as patients in our intensive care unit (31 vs. 16 vs. 10.2%, P = 0.19). CONCLUSION This is a snapshot of airway management experience across a single tertiary centre. Emergency airway management and locations outside the operating theatre had a higher complication rate with hypotension (SBP < 65 mmHg) being the most frequent physiological event followed by hypoxia (SpO 2 < 90%). Despite its limitations, we recommend using a QR code-linked web collection tool, as it allowed us to collect anonymised data on a significant number of patients over a short period. STUDY REGISTRATION The study was discussed with the Institutional Review Board, and approval (registration number CA2023/226) was provided by the Clinical Audit Committee.