Real-World Evaluation of i-gel Introduction on Intraoperative Airway-Related Safety Events: A Retrospective Cohort Study From a New England Hospital Network.

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.