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Background <p>Intraoperative medication errors, although uncommon, can result in considerable patient harm. Evidence remains limited regarding anesthesia provider-level and perioperative risk factors. This study aimed to evaluate whether anesthesia provider characteristics—particularly experience level and team composition—are statistically associated with intraoperative medication errors after multivariable adjustment.</p> Methods <p>We conducted a retrospective observational study of 100,093 surgical cases managed under anesthesia at a university-affiliated tertiary hospital in Japan between August 2011 and December 2023. Data were extracted from an electronic anesthesia record system linked to institutional medical records. Medication errors were mainly identified through anesthesia provider self-reporting, supplemented by reports from operating room nurses. Predictor variables included patient characteristics, procedural details, and the main explanatory variable was anesthesia provider configuration: attending, and resident or intern under the supervision of an attending anesthesiologist. Firth’s penalized logistic regression was used to adjust for confounding variables identified via a directed acyclic graph.</p> Results <p>Intraoperative medication errors occurred in 102 of 100,093 procedures (0.10%). Compared with attending anesthesiologists, the odds of medication error—adjusted for the familywise error rate (FWER) using the Holm–Bonferroni method—were significantly higher when care involved residents [OR 2.713; 95% CI, 1.283–6.815; <i>P</i> = 0.007] or interns [OR 3.272; 95% CI, 1.508–8.368; <i>P</i> = 0.003]. After multiplicity adjustment, no other factors—including age, American Society of Anesthesiologists Physical Status (ASA-PS) classification, and surgical urgency—were statistically associated with error risk. Sensitivity analyses confirmed the robustness of the main findings across different covariate sets.</p> Conclusions <p>Anesthesia provider characteristics were statistically associated with intraoperative medication error risk. These findings suggest the need for strengthened supervision, structured team roles, and systems-based safeguards in perioperative medication safety.</p>

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Primary anesthesia provider characteristics and risk factors for intraoperative medication errors: a retrospective cohort study

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  • 发表日期：

    2025年12月13日

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  • Kohei Ikeda,
  • Masayoshi Koike,
  • Seirin Yamazaki,
  • Sae Nakamura,
  • Shoichi Uezono

摘要

Background

Intraoperative medication errors, although uncommon, can result in considerable patient harm. Evidence remains limited regarding anesthesia provider-level and perioperative risk factors. This study aimed to evaluate whether anesthesia provider characteristics—particularly experience level and team composition—are statistically associated with intraoperative medication errors after multivariable adjustment.

Methods

We conducted a retrospective observational study of 100,093 surgical cases managed under anesthesia at a university-affiliated tertiary hospital in Japan between August 2011 and December 2023. Data were extracted from an electronic anesthesia record system linked to institutional medical records. Medication errors were mainly identified through anesthesia provider self-reporting, supplemented by reports from operating room nurses. Predictor variables included patient characteristics, procedural details, and the main explanatory variable was anesthesia provider configuration: attending, and resident or intern under the supervision of an attending anesthesiologist. Firth’s penalized logistic regression was used to adjust for confounding variables identified via a directed acyclic graph.

Results

Intraoperative medication errors occurred in 102 of 100,093 procedures (0.10%). Compared with attending anesthesiologists, the odds of medication error—adjusted for the familywise error rate (FWER) using the Holm–Bonferroni method—were significantly higher when care involved residents [OR 2.713; 95% CI, 1.283–6.815; P = 0.007] or interns [OR 3.272; 95% CI, 1.508–8.368; P = 0.003]. After multiplicity adjustment, no other factors—including age, American Society of Anesthesiologists Physical Status (ASA-PS) classification, and surgical urgency—were statistically associated with error risk. Sensitivity analyses confirmed the robustness of the main findings across different covariate sets.

Conclusions

Anesthesia provider characteristics were statistically associated with intraoperative medication error risk. These findings suggest the need for strengthened supervision, structured team roles, and systems-based safeguards in perioperative medication safety.