What Is the Incidence of Anesthesia-Related Adverse Events in Oral and Maxillofacial Surgery Offices? A Review of 61,237 Sedation Cases From a Large Private Practice Consortium

Steven J Wiemer; Jai Kumar Mediratta; Reese R Triana; James Card; David Rallis; Kevin L Rieck; Eric Holmes; Deepak G Krishnan

doi:10.1016/j.joms.2024.04.014

What Is the Incidence of Anesthesia-Related Adverse Events in Oral and Maxillofacial Surgery Offices? A Review of 61,237 Sedation Cases From a Large Private Practice Consortium

J Oral Maxillofac Surg. 2024 Apr 25:S0278-2391(24)00274-X. doi: 10.1016/j.joms.2024.04.014. Online ahead of print.

Authors

Steven J Wiemer¹, Jai Kumar Mediratta², Reese R Triana³, James Card⁴, David Rallis¹, Kevin L Rieck¹, Eric Holmes⁵, Deepak G Krishnan⁶

Affiliations

¹ Oral and Maxillofacial Surgeon, Nebraska Oral & Facial Surgery, Lincoln and Columbus, NE; Oral and Maxillofacial Surgeon, Paradigm Oral Health, Lincoln, NE.
² Resident, Mayo Clinic College of Medicine and Science, Division of Oral & Maxillofacial Surgery, Department of Surgery, Rochester, MN.
³ MBA Student, Boston University, Questrom School of Business, Boston, MA.
⁴ Vice President of Business Intelligence, Paradigm Oral Health, Lincoln, NE.
⁵ Clinical Research Coordinator, Division of Oral and Maxillofacial Surgery, Department of Surgery, University of Cincinnati, Cincinnati, OH.
⁶ Professor of Surgery, Section Chief, Division of Oral and Maxillofacial Surgery, Department of Surgery, University of Cincinnati, Cincinnati, OH. Electronic address: deepak.krishnan@uc.edu.

PMID: 38750658
DOI: 10.1016/j.joms.2024.04.014

Abstract

Background: The safety of the anesthesia team model performed in oral and maxillofacial surgery (OMS) offices has been criticized by professional and mainstream media.

Purpose: This study aims to assess the incidence of adverse events (AEs) associated with the OMS anesthesia team model and identify risk factors associated with AEs.

Study design, setting, sample: This was a retrospective cohort study utilizing a patient database from Paradigm Oral Health, Lincoln, Nebraska, a managed service organization (MSO). Subjects included were 14 and older, undergoing open-airway intravenous anesthesia for ambulatory OMS procedures using the OMS anesthesia team model at multiple private practices in the MSO network between June 30, 2010, and September 30, 2022. Exclusion criteria included patients younger than 14 or patients with incomplete medical records.

Predictor variable: Primary predictor variables were age, sex, American Society of Anesthesiologists physical status classification system (ASA) score, type of surgical procedure performed, and the types of medications administered during sedation.

Main outcome variable(s): The presence of an AE. The definition of an AE was modeled on the World Society of Intravenous Anesthesia definition. All AEs were identified through surrogate markers, which were identified through chart review. One example of an AE is ventricular fibrillation, which necessitates the application of medications; here the medication is the surrogate marker.

Covariates: None.

Analyses: The data were analyzed using t-tests and χ² tests. P values ≤ .05 were considered statistically significant.

Results: Included in the study were 61,237 sedation cases (53.87% female and 46.13% male), for 56,076 unique patients ranging from 14 to 98 years of age (mean 33.26 ± 18.35). An AE incidence of 3 per 100,000 per year (25 total events) was observed. Neither age, sex, ASA score, nor type of surgical procedure exhibited statistically significant associations with AEs. A statistically significant association was found between AEs and fentanyl (P = .0008).

Conclusion and relevance: This investigation shows a smaller incidence of AEs than previous studies of the OMS anesthesia team model.