RESUMEN
This report contains anesthesia-related mortality and morbidity in Japanese Society of Anesthesiologists Certified Training Hospitals (JSACTH) in the year 2000, as a part of the second series of annual studies started in 1999. JSA Committee on Operating Room Safety (CORS) sent confidential questionnaires to 794 JSACTH and received effective answers from 65.5% of hospitals. A total number of 941,217 anesthetics were documented. The respondents were asked to report all cases of cardiac arrests and other critical incidents (serious hypotension, serious hypoxemia and others), and their outcomes (death in operating room, death within 7 days, transfer to vegetative state and rescue without sequelae) as well as one principal cause for each incident from the list of 52 items. They were also requested to submit the tabulation of patients by ASA physical status, age distribution, surgery sites and anesthetic methods. Analysis was made by total incidents under anesthesia/surgery, and also by incidents totally attributable to anesthetic management (AM), due to preoperative complications (PC), due to intraoperative pathological events (IP) and due to surgery (SG). This paper focused analysis on entire patients, since analyses with special reference to ASA physical status, age distribution, surgery sites and anesthetic methods were reported previously. Total incidence of cardiac arrest under anesthesia/surgery was 6.52 per 10,000 anesthetics. PC, IP and SG occupied 46.4%, 19.1% and 23.0% of principal causes of total cardiac arrest, respectively. AM occupied only 8.1% of the principal causes and the incidence was 0.53 per 10,000. The most frequent cause of cardiac arrest in 52 more detailed classification of principal causes was preoperative hemorrhagic shock that occupied 23.3% of all cardiac arrests. The second was massive hemorrhage and/or hypovolemia due to surgical procedures (10.6%), and the third was surgery itself (9.5%). Prognosis of the cardiac arrest was worst in that due to PC, 73.7% of cardiac arrests died in the operating room or within 7 days after surgery and only 20.4% survived without sequelae. The best prognosis was found in cardiac arrest due to AM, 76.0% survived without sequelae and 12.0% died. The mortality rate after cardiac arrest was 3.52 per 10,000 anesthetics, of them 0.06 was due to AM, 0.39 due to IP, 2.23 due to PC and 0.76 due to SG. The mortality rate after critical incidents other than cardiac arrest such as severe hypotension and severe hypoxemia was 3.48, and of them 0.03 was due to AM, 0.18 due to IP, 2.45 due to PC and 0.81 due to SG. The final mortality rate attributable to anesthesia/surgery including deaths after cardiac arrest and after other critical incidents was 7.00 per 10,000 anesthetics and very close to 7.18 [6.22, 8.13], that of mean [95%C.I.] in 1994-1998, and 7.19 in 1999. The final mortality rate totally attributable to AM was 0.10 per 10,000 anesthetics, which was significantly improved from 0.21 [0.15, 0.27], that of mean [95%C.I.] in 1994-1998, but not different from 0.13 in 1999. IP, PC and SG showed the final mortality rate of 0.56, 4.69 and 1.57, respectively. Five major causes of all critical incidents were massive hemorrhage due to surgical procedures (13.8%), preoperative hemorrhagic shock (13.1%), surgical technique (8.6%), inappropriate airway management (6.2%) and preoperative respiratory complication (5.7%). Drug overdose or wrong choice (2.7%) as a human error occupied the 10th. In conclusion, the obtained incidences as to death, other critical incidents and their outcomes as well as the occurrence of principal causes in 2000 study were remarkably close to those in 1999 study. We expect that this second series of annual studies for five-years should reveal precise and definite direction for us to reduce anesthesia-related mortality and morbidity.
Asunto(s)
Anestesia/mortalidad , Anestesiología , Quirófanos/estadística & datos numéricos , Administración de la Seguridad/organización & administración , Sociedades Médicas , Informes Anuales como Asunto , Paro Cardíaco/epidemiología , Humanos , Hipotensión/epidemiología , Hipoxia/epidemiología , Incidencia , Japón/epidemiología , Morbilidad , Encuestas y Cuestionarios , Factores de TiempoRESUMEN
Perioperative mortality and morbidity in Japan for the year 2000 were analyzed with special reference to operative regions. The total number of analyzed cases was 903,086. The percentages for each operative region were as follows, CRANIOTOMY 4.5%, THORACOTOMY 3.5%, HEART and GREAT-VESSELS 3.7%, THORACOTOMY with LAPAROTOMY 0.7%, LAPAROTOMY 30.4%, CESARIAN SECTION 3.3%, HEAD-NECK-ENT 14.7%, CHEST-ABDOMEN-PERINEUM 14.0%, SUPINE 3.6%, EXTREMITY including PERIPHERAL-VESSEL 17.2%, OTHERS 4.4%. The incidence of serious events, including cardiac arrest and severe hypotension and hypoxemia developing to cardiac arrest, was 26.74 per 10,000 anesthetics in all operative regions. The events were observed more frequently in HEART and GREAT-VESSELS 170.39, THORACOTOMY with LAPAROTOMY 85.84 and THORACOTOMY 63.63, and less frequently in CHEST-ABDOMEN-PERINEUM 10.49, CESARIAN SECTION 10.95 and EXTREMITY including PERIPHERAL-VESSEL 13.42. Regarding the prognosis of events, the cases with no sequelae were 63.4% in all operative regions. While there were fewer cases with no sequelae in CRANIOTOMY 49.0%, THORACOTOMY with LAPAROTOMY 43.4% and HEART and GREAT-VESSELS 44.4%, there were more cases in HEAD-NECK-ENT 86.9% and CHEST-ABDOMEN-PERINEUM 89.5%. The incidence of serious events totally attributable to anesthetic management was 5.24 per 10,000 anesthetics in all operative regions. The events were observed more frequently in THORACOTOMY 12.91 and SPINE 8.02, and less frequently in LAPAROTOMY except CESARIAN SECTION 4.11 and EXTREMITY including PERIPHERAL-VESSEL 4.65. The main cause of events in THORACOTOMY was inadequate airway management and in SPINE was inadequate airway management and the overdose or miss selection for drugs. Regarding the prognosis of events totally attributable to anesthetic management, the cases with no sequelae were 91.8% in all operative regions. There were fewer cases with no sequelae in HEART and GREAT-VESSELS 82.6%. The incidence of serious events totally attributable to anesthetic management was one fifth of all serious events in all operative regions. While the total deaths from 903,086 cases, including deaths in the operating room or within 7 postoperative days, were 641 cases (7.10 per 10,000 cases), the deaths totally attributable to anesthesia were 9 cases (0.10 per 10,000 cases).
Asunto(s)
Anestesia/mortalidad , Anestesiología/normas , Hospitales de Enseñanza/normas , Quirófanos/normas , Anestesia/estadística & datos numéricos , Paro Cardíaco/mortalidad , Mortalidad Hospitalaria , Humanos , Incidencia , Japón/epidemiología , Morbilidad , Seguridad , Sociedades Médicas , Procedimientos Quirúrgicos Operativos/mortalidad , Encuestas y CuestionariosRESUMEN
Perioperative mortality and morbidity in Japan from Jan. 1 to Dec. 31, 2000 were studied retrospectively. Committee on Operating Room Safety in Japanese Society of Anesthesiologists (JSA) sent confidential questionnaires to 794 certified training hospitals of JSA and received answers from 67.6% of the hospitals. We analyzed their answers with a special reference to ASA physical status (ASA-PS). The total number of anesthesia available for this analysis was 897,733. The percentages of patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E are 38.0, 40.3, 8.5, 0.4, 4.3, 5.3, 2.5, and 0.7%, respectively. Mortality and morbidity from all kinds of causes including anesthetic management, intraoperative events, co-existing diseases, and surgical problems were as follows. The incidences of cardiac arrest (per 10,000 cases of anesthesia) were 1.11, 3.26, 12.25, 54.60, 0.77, 4.46, 21.08 and 217.75 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The incidences of critical events including cardiac arrest, severe hypotension, and severe hypoxemia were 6.89, 20.22, 62.18, 148.21, 6.71, 20.38, 106.72 and 592.21 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The mortality rates (death during anesthesia and within 7 postoperative days) after cardiac arrest were 0.26, 0.77, 3.69, 41.60, 0.00, 1.06, 9.42 and 163.31 per 10,000 cases of anesthesia in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The overall mortality rates were 0.32, 1.38, 9.75, 70.20, 0.26, 2.12, 29.15 and 353.02 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. Overall mortality and morbidity were higher in emergency anesthesia than in elective anesthesia. ASA-PS correlated well with overall mortality and morbidity, regardless of etiology. The incidences of cardiac arrest totally attributable to anesthesia were 0.23, 0.50, 1.32, 0.00, 0.00, 0.85, 2.69 and 4.95 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The incidences of all critical events totally attributable to anesthesia were 3.13, 5.56, 11.46, 5.20, 3.87, 5.94, 13.90 and 14.85 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The mortality rates after cardiac arrest totally attributable to anesthesia were 0.03, 0.03, 0.00, 0.00, 0.00, 0.21, 0.45 and 3.30 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The overall mortality rates totally attributable to anesthesia were 0.03, 0.06, 0.00, 0.00, 0.00, 0.21, 0.45 and 6.60 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The overall mortality rate totally attributable to anesthesia among patients with good physical status (ASA-PS of I, II, I E, II E) was 0.05. Anesthetic management was mainly responsible for critical events in patients with good physical status, while coexisting diseases were in those with poor physical status. Surgical problems including procedures and massive hemorrhage were the leading causes of mortality in patients with good physical status. We reconfirmed that ASA-PS is useful to predict perioperative mortality and morbidity. It also seems likely that we should make much more efforts to reduce anesthetic morbidity in patients with good physical status, and to improve preanesthetic assessment and preparation in those with poor physical status. Reducing mortality and morbidity from surgical problems is also required for improving perioperative mortality.