Department of Anesthesia and Perioperative Medicine, University of Western Ontario, London, ON, Canada.
Lancet. 2012 Sep 22;380(9847):1075-81. doi: 10.1016/S0140-6736(12)60990-8.
The magnitude of risk of death related to surgery and anaesthesia is not well understood. We aimed to assess whether the risk of perioperative and anaesthetic-related mortality has decreased over the past five decades and whether rates of decline have been comparable in developed and developing countries.
We did a systematic review to identify all studies published up to February, 2011, in any language, with a sample size of over 3000 that reported perioperative mortality across a mixed surgical population who had undergone general anaesthesia. Using standard forms, two authors independently identified studies for inclusion and extracted information on rates of anaesthetic-related mortality, perioperative mortality, cardiac arrest, American Society of Anesthesiologists (ASA) physical status, geographic location, human development index (HDI), and year. The primary outcome was anaesthetic sole mortality. Secondary outcomes were anaesthetic contributory mortality, total perioperative mortality, and cardiac arrest. Meta-regression was done to ascertain weighted event rates for the outcomes.
87 studies met the inclusion criteria, within which there were more than 21·4 million anaesthetic administrations given to patients undergoing general anaesthesia for surgery. Mortality solely attributable to anaesthesia declined over time, from 357 per million (95% CI 324-394) before the 1970s to 52 per million (42-64) in the 1970s-80s, and 34 per million (29-39) in the 1990s-2000s (p<0·00001). Total perioperative mortality decreased over time, from 10,603 per million (95% CI 10,423-10,784) before the 1970s, to 4533 per million (4405-4664) in the 1970s-80s, and 1176 per million (1148-1205) in the 1990s-2000s (p<0·0001). Meta-regression showed a significant relation between risk of perioperative and anaesthetic-related mortality and HDI (all p<0·00001). Baseline risk status of patients who presented for surgery as shown by the ASA score increased over the decades (p<0·0001).
Despite increasing patient baseline risk, perioperative mortality has declined significantly over the past 50 years, with the greatest decline in developed countries. Global priority should be given to reducing total perioperative and anaesthetic-related mortality by evidence-based best practice in developing countries.
University of Western Ontario.
与手术和麻醉相关的死亡风险的严重程度尚不清楚。我们旨在评估过去五十年间围手术期和麻醉相关死亡率是否有所降低，以及在发达国家和发展中国家，死亡率的下降速度是否具有可比性。
我们进行了系统评价，以确定截至 2011 年 2 月发表的所有语言的研究，样本量超过 3000 例，报告了接受全身麻醉的混合外科人群的围手术期死亡率。两位作者使用标准表格独立确定纳入的研究，并提取麻醉相关死亡率、围手术期死亡率、心脏骤停、美国麻醉医师协会（ASA）身体状况、地理位置、人类发展指数（HDI）和年份等信息。主要结局是麻醉单一死亡率。次要结局是麻醉促成死亡率、总围手术期死亡率和心脏骤停。进行了荟萃回归以确定结局的加权事件率。
87 项研究符合纳入标准，其中有超过 2140 万例接受全身麻醉的患者接受了手术。单独归因于麻醉的死亡率随着时间的推移而下降，从 20 世纪 70 年代前的每百万 357 例（95%CI 324-394）降至 70-80 年代的每百万 52 例（42-64），90-2000 年代的每百万 34 例（29-39）（p<0·00001）。总围手术期死亡率随着时间的推移而下降，从 20 世纪 70 年代前的每百万 10603 例（95%CI 10423-10784）降至 70-80 年代的每百万 4533 例（4405-4664），90-2000 年代的每百万 1176 例（1148-1205）（p<0·0001）。荟萃回归显示，围手术期和麻醉相关死亡率与人类发展指数之间存在显著关系（均 p<0·00001）。患者在接受手术时的基础风险状况（以 ASA 评分表示）随着时间的推移而增加（p<0·0001）。
尽管患者的基础风险不断增加，但过去 50 年来围手术期死亡率显著下降，发达国家的降幅最大。发展中国家应优先通过循证最佳实践降低总围手术期和麻醉相关死亡率。
西安大略大学。
