Irita K, Kawashima Y, Kobayashi T, Goto Y, Morita K, Iwao Y, Seo N, Tsuzaki K, Dohi S
Masui. 2001 Jun;50(6):678-91.
Perioperative mortality and morbidity in Japan for the year 1999 were studied retrospectively. Committee on Operating Room Safety of the Japan Society of Anesthesiologists (JSA) sent confidential questionnaires to 774 Certified Training Hospitals of JSA and received answers from 60.2% of the hospitals. We analyzed their answers with special reference to ASA physical status (ASA-PS). The total number of anesthetics analyzed was 655, 644. Mortality and morbidity due to all kinds of causes including anesthetic management, intraoperative events, co-existing diseases, and operation were as follows. The incidence of cardiac arrest (per 10,000 anesthetics) was 0.68, 3.76, 14.37, 67.03, 0.36, 4.68, 27.96, 206.30 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 8.93, 26.99, 71.30, 188.52, 8.68, 31.27, 136.16, and 790.92 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 7th postoperative day) after cardiac arrest were 0.16, 0.94, 5.71, 33.51, 0.00, 1.46, 16.41 and 167.76 per 10,000 anesthetics 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 0.24, 1.66, 12.16, 67.03, 0.00, 3.51, 34.65 and 417.14 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 anesthetics than in elective anesthetics. ASA-PS correlated well with overall mortality and with morbidity, regardless of etiology. The incidences of cardiac arrest totally attributable to anesthesia were 0.24, 0.45, 1.47, 8.38, 0.36, 1.75, 2.43 and 11.34 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 4.92, 8.81, 14.74, 20.95, 4.34, 11.40, 15.80 and 22.67 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 0.00, 0.00, 0.61 and 4.53 in patients with ASA-PS of I-IV, I E-II E, III E, and IV E, respectively. The overall mortality rates totally attributable to anesthesia were 0.00, 0.04, 0.18, 0.00, 0.00, 0.61 and 4.53 in patients classified to ASA-PS of I, II, III, IV, I E-II E, III E, and IV E, respectively. Only one death, due to overdose of anesthetics, was reported among patients with good physical status (ASA-PS of I, II, II E and II E). Anesthetic management was mainly responsible for critical events in patients with good physical status, while co-existing diseases were in those with poor physical status. The major co-existing diseases or conditions leading to critical events were heart diseases in elective anesthetics, and hemorrhagic shock in emergency anesthetics. We reconfirmed that ASA-PS is beneficial 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 of cardiovascular conditions in those with poor physical status.
对1999年日本围手术期死亡率和发病率进行了回顾性研究。日本麻醉医师协会手术室安全委员会向774家日本麻醉医师协会认证培训医院发送了保密问卷，收到了60.2%的医院的回复。我们特别参照美国麻醉医师协会身体状况分级（ASA-PS）对回复进行了分析。分析的麻醉总数为655644例。包括麻醉管理、术中事件、并存疾病和手术在内的各种原因导致的死亡率和发病率如下。ASA-PS为I、II、III、IV、I E、II E、III E和IV E的患者心脏骤停发生率（每10000例麻醉）分别为0.68、3.76、14.37、67.03、0.36、4.68、27.96和206.30。ASA-PS为I、II、III、IV、I E、II E、III E和IV E的患者包括心脏骤停、严重低血压和严重低氧血症在内的严重事件发生率分别为8.93、26.99、71.30、188.52、8.68、31.27、136.16和790.92。ASA-PS为I、II、III、IV、I E、II E、III E和IV E的患者心脏骤停后的死亡率（麻醉期间及术后第7天内死亡）分别为每10000例麻醉0.16、0.94、5.71、33.51、0.00、1.46、16.41和167.76。ASA-PS为I、II、III、IV、I E、II E、III E和IV E的患者总体死亡率分别为0.24、1.66、12.16、67.03、0.00、3.51、34.65和417.14。急诊麻醉的总体死亡率和发病率高于择期麻醉。无论病因如何，ASA-PS与总体死亡率和发病率均密切相关。ASA-PS为I、II、III、IV、I E、II E、III E和IV E的患者完全归因于麻醉的心脏骤停发生率分别为0.24、0.45、1.47、8.38、0.36、1.75、2.43和11.34。ASA-PS为I、II、III、IV、I E、II E、III E和IV E的患者完全归因于麻醉的所有严重事件发生率分别为4.92、8.81、14.74、20.95、4.34、11.40、15.80和22.67。ASA-PS为I-IV、I E-II E、III E和IV E的患者完全归因于麻醉的心脏骤停后的死亡率分别为0.00、0.00、0.61和4.53。分类为ASA-PS为I、II、III、IV、I E-II E、III E和IV E的患者完全归因于麻醉的总体死亡率分别为0.00、0.04、0.18、0.00、0.00、0.61和4.53。身体状况良好（ASA-PS为I、II、II E和II E）的患者中仅报告了1例因麻醉药过量导致的死亡。麻醉管理是身体状况良好患者严重事件的主要原因，而并存疾病是身体状况较差患者严重事件的主要原因。导致严重事件的主要并存疾病或状况在择期麻醉中是心脏病，在急诊麻醉中是失血性休克。我们再次证实ASA-PS有助于预测围手术期死亡率和发病率。似乎我们还应更加努力降低身体状况良好患者的麻醉发病率，并改善身体状况较差患者麻醉前对心血管状况的评估和准备。
