BACKGROUND:
Several health care networks have fully adopted second-generation supraglottic airway (SGA) i-gel. Real-world evidence of enhanced patient safety after such practice change is lacking. We hypothesized that the implementation of i-gel compared to the previous LMA®-Unique™ would be associated with a lower risk of airway-related safety events.
METHODS:
Adult patients undergoing general anesthesia with LMA-Unique or i-gel between January 2013 and June 2020 at an academic health care network were included. We assessed the influence of i-gel implementation on the trends of intraoperative airway-related safety events, a composite outcome of respiratory disturbances including intraoperative desaturation (<90%), hypo- or hypercapnia (<25 or >50 mm Hg), high driving pressures (>30 cmH2O), low tidal volumes (<4 mL/kg), multiple attempts of SGA placement, or emergency replacement with a tracheal tube, using adjusted ordinary least-squares regression interrupted time series analysis.
RESULTS:
A total of 21,417 patients were included, and 5193 experienced airway-related safety events (24.2%). After the wider uptake of i-gel in January 2018, the reduction in the monthly trend of airway-related safety events was magnified to −0.3% per month (95% confidence interval [CI], −0.1% to −0.4%, P < .001), compared to the LMA-Unique period (−0.2% per month, 95% CI, −0.1% to −0.3%; P = .002).
CONCLUSIONS:
We found a significant decline in the monthly trend of airway-related safety events after the full implementation of i-gel in our health care network. This study provides real-world patient safety and clinical effectiveness information to clinicians and decision-makers.
KEY POINTS
- Question: Was the implementation of i-gel, in contrast to previous LMA®-Unique™, associated with a lower risk of intraoperative airway-related safety events?
- Findings: In this hospital registry study of 21,417 patients, we found that the full implementation of i-gel was associated with a magnified reduction in the monthly trend of airway-related safety events by 0.3% per month, compared to the previous 0.2% monthly.
- Meaning: The implementation of i-gel in a large academic medical center was associated with a significant improvement in airway safety, providing important clinical effectiveness and patient safety information for clinicians and decision-makers.