Risk Factors for and Prediction of a Difficult Neuraxial Block: A Cohort Study of 73,579 Patients from the Danish Anaesthesia Database

TY - JOUR

T1 - Risk Factors for and Prediction of a Difficult Neuraxial Block

T2 - A Cohort Study of 73,579 Patients from the Danish Anaesthesia Database

AU - Stendell, Line

AU - Lundstrøm, Lars H

AU - Wetterslev, Jørn

AU - Itenov, Theis Skovsgaard

AU - Rosenstock, Charlotte V

PY - 2015/9/3

Y1 - 2015/9/3

N2 - BACKGROUND: A difficult neuraxial block (DNB) may be associated with complications. The aims of this study were to estimate the prevalence of DNB, assess patient-related and organizational factors associated with DNB, and evaluate the diagnostic accuracy of an accumulated risk score for predicting DNB.METHODS: A consecutive cohort of 73,579 patients was retrieved. A predefined DNB score and information on patient-related and organizational factors were included in the analyses. Logistic regression analysis was performed. We evaluated the diagnostic accuracy of an accumulated weighted point score of the patient-related risk factors of DNB.RESULTS: The prevalence of DNB and abandoned neuraxial block was 3.9 (95% confidence interval [95% CI], 3.7-4.0) and 0.2 (95% CI, 0.16-0.22), respectively. Body mass index of 35 or higher and previous DNB were associated with DNB, with 3.23 (95% CI, 2.87-3.65) and 2.00 (95% CI, 1.33-3.00), respectively. However, the remaining patient-related covariates were associated with DNB with substantial lower odds ratios. The diagnostic accuracy of an accumulated sum score demonstrated an area under the curve of 0.62 (95% CI, 0.61-0.64), a positive predictive value of 5%, and a positive likelihood ratio of 1.4.CONCLUSIONS: Despite of strong statistical association between DNB and the tested risk factors, the low odds ratios and estimates of the diagnostic test indicate that the clinical impact using an accumulated risk sum score is limited.

AB - BACKGROUND: A difficult neuraxial block (DNB) may be associated with complications. The aims of this study were to estimate the prevalence of DNB, assess patient-related and organizational factors associated with DNB, and evaluate the diagnostic accuracy of an accumulated risk score for predicting DNB.METHODS: A consecutive cohort of 73,579 patients was retrieved. A predefined DNB score and information on patient-related and organizational factors were included in the analyses. Logistic regression analysis was performed. We evaluated the diagnostic accuracy of an accumulated weighted point score of the patient-related risk factors of DNB.RESULTS: The prevalence of DNB and abandoned neuraxial block was 3.9 (95% confidence interval [95% CI], 3.7-4.0) and 0.2 (95% CI, 0.16-0.22), respectively. Body mass index of 35 or higher and previous DNB were associated with DNB, with 3.23 (95% CI, 2.87-3.65) and 2.00 (95% CI, 1.33-3.00), respectively. However, the remaining patient-related covariates were associated with DNB with substantial lower odds ratios. The diagnostic accuracy of an accumulated sum score demonstrated an area under the curve of 0.62 (95% CI, 0.61-0.64), a positive predictive value of 5%, and a positive likelihood ratio of 1.4.CONCLUSIONS: Despite of strong statistical association between DNB and the tested risk factors, the low odds ratios and estimates of the diagnostic test indicate that the clinical impact using an accumulated risk sum score is limited.

KW - Aged

KW - Anesthesia

KW - Cohort Studies

KW - Databases, Factual

KW - Denmark

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Nerve Block

KW - Postoperative Complications

KW - Predictive Value of Tests

KW - Risk Factors

U2 - 10.1097/AAP.0000000000000293

DO - 10.1097/AAP.0000000000000293

M3 - Journal article

C2 - 26237000

SN - 1098-7339

VL - 40

SP - 545

EP - 552

JO - Regional Anesthesia and Pain Medicine

JF - Regional Anesthesia and Pain Medicine

IS - 5

ER -