Clinical audit NAP7: key trends
The latest NAP7, published in Anaesthesia (a journal of the Association of Anaesthetists), reveals a worrying picture of increasing age, rates of obesity, and complexity of surgical patients requiring anaesthesia in the UK.1 l The average age of patients requiring anaesthesia increased by 2.3 years (from 50.5 to 52.8) over the last decade.
l Average BMI of patients also increased by almost two points from 24.9 (borderline normal/overweight) to 26.7 (overweight).
l The proportion of patients described as being of the lowest complexity decreased from more than a third (37%) to less than a quarter (24%) of total cases.
l The overall effect of the COVID pandemic on these numbers is unclear, but these trends have the potential to add considerable pressure to an already strained NHS – older, more unwell patients will be hospitalised for longer and waiting lists more difficult to clear.
surgeons, anaesthetists, nurses, and managers in the NHS. The seventh National Audit Project, or NAP, has also been built using the CaseCapture clinical audit tool. NAP audits provide new understanding on complications of low incidence, but high risk, studying rare but potentially serious anaesthesia-related complications. NAP7 examines perioperative cardiac arrest, and has seen data collected from more than 350 hospital sites. “A CaseCapture dataset was created so hospitals can log their case, so that it can be examined by a review panel,” explains Lourtie. An activity survey published in February 2023
revealed important trends from data collected in the NAP7 Audit. In particular, it found that patients requiring anaesthesia in the UK were showing increases in rates of obesity, as well as their age, and their complexity. This, the report concluded, was likely to have a significant impact for peri-operative services in the UK.
The snapshot activity survey collected patient- level data from all cases under the care of an anaesthetist in UK hospitals delivering anaesthesia in November 2021. Anaesthetists recorded details of all cases undertaken over four days at their institution through an online survey capturing anonymous patient characteristics and anaesthetic details. Of 416 hospital sites invited to participate, 352 (85%) completed the activity survey. A total of 24,172 reports were included in the final dataset. This new research is the first set of results available from NAP7, with the full report due to be published in November 2023. Dr. Andrew Kane, lead author, says: “The fact that the population requiring surgery with anaesthesia is 2.3 years older than nine years ago has important implications. Although this may seem a modest increase in age, the all-cause mortality in the general population increases approximately 10% for each year of
A series of snapshot audits has also been
created using similar tools to CaseCapture to help improve outcomes in particular areas – for example frailty and delirium. Known as Sprint National Anaesthesia Projects, or SNAPs, these studies capture data in relation to a large number of patients over just a few days, with preparation and analysis of the data taking place over a longer period. They are designed to study common events related to anaesthesia and surgery, which affect many patients. The first SNAP audit examined patient satisfaction following anaesthesia, in order to create a new national benchmark that hospitals could then use to compare their own service delivery, and highlight when action is needed in quality improvement. The audit also looked to create a better understanding of the level of accidental awareness during general anaesthesia, among patients in the UK.
advancing age and doubles as age increases 6–7 years; and thus a 2.3-year increase in age equates to an approximately 27% increase in all-cause mortality. This increase in age is likely to interact with peri-operative risk, most notably for those patients who are elderly, meaning that morbidity, mortality and healthcare costs might all be expected to have risen.”
Reference 1. Kane, A.D., Soar, J., Armstrong, R.A., Kursumovic, E., Davies, M.T., Oglesby, F.C., Cortes, L., Taylor, C., Moppett, I.K., Agarwal, S., Cordingley, J., Dorey, J., Finney, S.J., Kunst, G., Lucas, D.N., Nickols, G., Mouton, R., Nolan, J.P., Patel, B., Pappachan, V.J., Plaat, F., Scholefield, B.R., Smith, J.H., Varney, L., Cook, T.M. and (2023), Patient characteristics, anaesthetic workload and techniques in the UK: an analysis from the 7th National Audit Project (NAP7) activity survey. Anaesthesia, 78: 701-711.
https://doi.org/10.1111/anae.15989
SNAP3 – the latest SNAP audit – examines issues in relation to frailty and delirium, with a significant focus on creating a better understanding of quality of life for patients following surgery. It is just the latest in a continuing stream of studies created in a collaborative way, driven by a fundamental objective to intelligently understand how services are performing, and how they can be improved for patients receiving care.
About the author
Jose Lourtie is the head of research at the Royal College of Anaesthetists. Responsible for overseeing a programme of healthcare improvement and research and managing the work of the Research Department. This encompasses the National Institute for Academic Anaesthesia (NIAA) and the Health Services Research Centre (HSRC) and the strategic objectives of those respective bodies and any of their offshoots, such as the NIAA Clinical Trials Network (CTN). It also includes the grants awarded and research projects overseen by them, such as the National Audit Projects (NAPs), the National Emergency Laparotomy Audit (NELA), the Sprint National Anaesthesia Projects (SNAPs) and the Perioperative Medicine Quality Improvement Programme (PQIP). Jose has worked in the charitable and healthcare sector for over 20 years.
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