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Interventional Procedures Outside of the Operating Room

Results From the National Anesthesia Clinical Outcomes Registry

Chang, Beverly MD*; Kaye, Alan D. MD, PhD; Diaz, James H. MD, MPH†‡; Westlake, Benjamin BS§; Dutton, Richard P. MD, MBA§∥; Urman, Richard D. MD, MBA*

doi: 10.1097/PTS.0000000000000156
Original Articles

Objectives This study examines the impact of procedural locations and types of anesthetics on patient outcomes in non-operating room anesthesia (NORA) locations. The National Anesthesia Clinical Outcomes Registry database was examined to compare OR to NORA anesthetic complications and patient demographics.

Methods The National Anesthesia Clinical Outcomes Registry database was examined for all patient procedures from 2010 to 2013. A total of 12,252,846 cases were analyzed, with 205 practices contributing information, representing 1494 facilities and 7767 physician providers. Cases were separated on the basis of procedure location, OR, or NORA. Subgroup analysis examined outcomes from specific subspecialties.

Results NORA procedures were performed on a higher percentage of patients older than 50 years (61.92% versus 55.56%, P < 0.0001). Monitored anesthesia care (MAC) (20.15%) and sedation (2.05%) were more common in NORA locations. The most common minor complications were postoperative nausea and vomiting (1.06%), inadequate pain control (1.01%), and hemodynamic instability (0.62%). The most common major complications were serious hemodynamic instability (0.10%) and upgrade of care (0.10%). There was a greater incidence of complications in cardiology and radiology locations. Overall mortality was higher in OR versus NORA (0.04% versus 0.02%, P < 0.0001). Subcategory analysis showed increased incidence of death in cardiology and radiology locations (0.05%).

Conclusions NORA procedures have lower morbidity and mortality rates than OR procedures, contrary to some previously published studies. However, the increased complication rates in both the cardiology and radiology locations may need to be the target of future safety investigations. Providers must ensure proper monitoring of patients, and NORA locations need to be held to the same standard of care as the main operating room. Further studies need to identify at-risk patients and procedures that may predispose patients to complications.

From the *Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; †Department of Anesthesiology, Louisiana State University; ‡Environmental and Occupational Health Sciences, School of Public Health, Louisiana State University, New Orleans, Louisiana; §Anesthesia Quality Institute, Schaumburg, Illinois; and ∥Department of Anesthesiology, The University of Chicago, Chicago, Illinois.

Correspondence: Richard D. Urman, MD, MBA, Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115 (e-mail:

The authors disclose no conflict of interest.

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