Patient characteristics, anaesthetic workload and techniques in the UK: an analysis from the 7th National Audit Project (NAP7) activity survey

A D Kane; J Soar; R A Armstrong; E Kursumovic; M T Davies; F C Oglesby; L Cortes; C Taylor; I K Moppett; S Agarwal; J Cordingley; J Dorey; S J Finney; G Kunst; D N Lucas; G Nickols; R Mouton; J P Nolan; B Patel; V J Pappachan; F Plaat; B R Scholefield; J H Smith; L Varney; T M Cook; collaborators

doi:10.1111/anae.15989

Patient characteristics, anaesthetic workload and techniques in the UK: an analysis from the 7th National Audit Project (NAP7) activity survey

Anaesthesia. 2023 Jun;78(6):701-711. doi: 10.1111/anae.15989. Epub 2023 Mar 1.

Authors

A D Kane^{1

2}, J Soar³, R A Armstrong^{1

4}, E Kursumovic^{1

5}, M T Davies⁶, F C Oglesby⁷, L Cortes¹, C Taylor¹, I K Moppett^{1

8}, S Agarwal⁹, J Cordingley¹⁰, J Dorey¹, S J Finney¹⁰, G Kunst¹¹, D N Lucas¹², G Nickols¹³, R Mouton¹³, J P Nolan¹⁴, B Patel¹, V J Pappachan¹⁵, F Plaat¹⁶, B R Scholefield¹⁷, J H Smith¹⁸, L Varney¹⁹, T M Cook^{5

20}; collaborators

Affiliations

¹ Royal College of Anaesthetists, Red Lion Square, UK.
² Department of Anaesthesia, James Cook University Hospital, South Tees NHS Foundation Trust, Middlesbrough, UK.
³ Department of Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK.
⁴ Department of Anaesthesia, Severn Deanery, Bristol, UK.
⁵ Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK.
⁶ Department of Critical Care and Anaesthesia, North West Anglia NHS Trust, UK.
⁷ University Hospitals Bristol and Weston NHS Foundation Trust, UK.
⁸ University of Nottingham, UK.
⁹ Department of Anaesthesia, Manchester University Hospitals Foundation Trust, Manchester, UK.
¹⁰ Department of Critical Care and Anaesthesia, Barts Health NHS Trust, UK.
¹¹ Department of Cardiovascular Anaesthesia, Kings College London, UK.
¹² Department of Anaesthesia, London North West University Healthcare NHS Trust, UK.
¹³ Department of Anaesthesia, North Bristol NHS Trust, Bristol, UK.
¹⁴ Resuscitation Medicine, Warwick Clinical Trials Unit, University of Warwick, Coventry, UK.
¹⁵ Southampton Children's Hospital, NIHR Biomedical Research Centre, Department of Paediatric Anaesthesia and Intensive Care Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
¹⁶ Department of Anaesthesia, Imperial College Healthcare NHS Trust, London, UK.
¹⁷ Institute of Inflammation and Ageing, University of Birmingham, UK.
¹⁸ Department of Anaesthesia, Great Ormond Street Hospital, London, UK.
¹⁹ Department of Anaesthesia, University College London Hospitals, London, UK.
²⁰ University of Bristol, UK.

PMID: 36857758
DOI: 10.1111/anae.15989

Abstract

Detailed contemporary knowledge of the characteristics of the surgical population, national anaesthetic workload, anaesthetic techniques and behaviours are essential to monitor productivity, inform policy and direct research themes. Every 3-4 years, the Royal College of Anaesthetists, as part of its National Audit Projects (NAP), performs a snapshot activity survey in all UK hospitals delivering anaesthesia, collecting patient-level encounter data from all cases under the care of an anaesthetist. During November 2021, as part of NAP7, anaesthetists recorded details of all cases undertaken over 4 days at their site through an online survey capturing anonymous patient characteristics and anaesthetic details. Of 416 hospital sites invited to participate, 352 (85%) completed the activity survey. From these, 24,177 reports were returned, of which 24,172 (99%) were included in the final dataset. The work patterns by day of the week, time of day and surgical specialty were similar to previous NAP activity surveys. However, in non-obstetric patients, between NAP5 (2013) and NAP7 (2021) activity surveys, the estimated median age of patients increased by 2.3 years from median (IQR) of 50.5 (28.4-69.1) to 52.8 (32.1-69.2) years. The median (IQR) BMI increased from 24.9 (21.5-29.5) to 26.7 (22.3-31.7) kg.m^-2 . The proportion of patients who scored as ASA physical status 1 decreased from 37% in NAP5 to 24% in NAP7. The use of total intravenous anaesthesia increased from 8% of general anaesthesia cases to 26% between NAP5 and NAP7. Some changes may reflect the impact of the COVID-19 pandemic on the anaesthetic population, though patients with confirmed COVID-19 accounted for only 149 (1%) cases. These data show a rising burden of age, obesity and comorbidity in patients requiring anaesthesia care, likely to impact UK peri-operative services significantly.

Keywords: ASA; BMI; COVID-19; NAP7; TIVA; activity survey; anaesthesia; comorbidity; obesity; processed EEG; regional anaesthesia; surgical activity.

MeSH terms

Anesthesia, General / methods
Anesthetics*
COVID-19* / epidemiology
Child, Preschool
Humans
Pandemics
United Kingdom / epidemiology
Workload

Substances

Anesthetics

Grants and funding

Royal College of Anaesthetists