Patient and surgery factors associated with the incidence of failed and difficult intubation

R. Schnittker, S. D. Marshall, J. Berecki-Gisolf

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25 Citations (Scopus)


Estimates of the rate and risk-factors for difficult airway rarely include a denominator for the number of anaesthetics. Approaches such as self-reporting and crowd-sourcing of airway incidents may help identify specific lessons from clinical episodes, but the lack of denominator data, biased reporting and under-reporting does not allow a comprehensive population-based assessment. We used an established state-wide dataset to determine the incidence of failed and difficult intubations between 2015 and 2017 in the state of Victoria in Australia, along with associated patient and surgical risk-factors. A total of 861,533 general anaesthesia episodes were analysed. Of these, 4092 patients with difficult or failed intubation were identified; incidence rates of 0.52% (2015–2016) and 0.43% (2016–2017), respectively. Difficult/failed intubations were most common in patients aged 45–75 and decreased for older age groups, with risk being lower for patients aged >85 than patients aged 35–44. The risk for failed/difficult intubation increased significantly for: patients undergoing emergency surgery (OR 1.80); obese patients (OR 2.48); increased ASA physical status; and increased Charlson Comorbidity Index. Across all age groups, procedures on the nervous system (OR 1.92) and endocrine system (OR 2.03) had the highest risk of failed/difficult intubation. The relative reduced risk for failed/difficult intubations in the elderly population is a novel finding that contrasts with previous research and may suggest a ‘compression of morbidity’ effect as a moderator. Administrative databases have the potential to improve understanding of peri-operative risk of rare events at a population level.

Original languageEnglish
Pages (from-to)756-766
Number of pages11
Issue number6
Publication statusPublished - Jun 2020


  • airway management
  • anaesthesia
  • database
  • difficult intubation

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