In Response

Abstract

We commend Overdyk and Walker1 for applying the unplanned intubation risk index (UIRI) to their registry data and reporting their preliminary finding that unplanned intubation (UI) within 48 hours of surgery in “low risk” patients is more likely to be related to issues in anesthesia care than in “high risk” patients. Although Overdyk and Walker categorized their patients as low-risk and high-risk patients by the UIRI, it is unclear what the cutoff point was in their risk stratification. The sensitivity and specificity of the UIRI, which ranges from 0 to 18 points, would depend on the cutoff point chosen by the investigators. Furthermore, the UIRI was developed to evaluate the risk of UI over the first 30 postoperative days, whereas Overdyk and Walker focused on events occurring only in the immediate postoperative period. Thus, their finding is not unexpected given that causes of early UI events are more likely to be related to anesthesia care, whereas UI events occurring later in the postoperative period are less likely to be affected by choices made in the operating room. Nevertheless, their preliminary finding is interesting and plausible, and if confirmed, may lead to the development of effective clinical interventions and quality improvement programs to reduce preventable postoperative morbidity and mortality. Finally, we agree that the use of clinical registry data is essential to improve patient safety in anesthesia, because the major adverse events related to anesthesia are rare. Efforts to develop the necessary clinical registries containing detailed anesthetic information (such as the Anesthesia Quality Institute) are underway and will be instrumental in further improving the quality of anesthesia care. May Hua, MD Department of Anesthesiology Columbia University College of Physicians and Surgeons New York, NY [email protected] Joanne E. Brady, SM Department of Epidemiology Columbia University Mailman School of Public Health New York, NY Guohua Li, MD, DrPH Center for Health Policy and Outcomes in Anesthesia and Critical Care Department of Anesthesiology Columbia University College of Physicians and Surgeons New York, NY