Boehm O, Pfeiffer M K A, Baumgarten G, Hoeft A
Klinik und Poliklinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Deutschland.
Anaesthesist. 2015 Nov;64(11):814-27. doi: 10.1007/s00101-015-0110-y.
Although anesthesia-associated mortality has been significantly reduced down to 0.00068-0.00082% over the last decades, recent studies have revealed a high perioperative mortality of 0.8- 4%. Apart from anesthesia and surgery-induced major complications, perioperative mortality is primarily negatively influenced by individual patient comorbidities. These risk factors predispose for acute critical incidents (e.g., myocardial infarction); however, the majority of fatal complications are a result of slowly progressing conditions, particularly infections or the sequelae of systemic inflammation. This implicates a broad window of opportunity for the detection and treatment of slow-onset complications to improve the perioperative outcome. The term "failure to rescue" (FTR), i.e., the proportion of patients who die from major complications compared to the number of all patients with complications, has been introduced as a valid indicator for the quality of perioperative care. Growing evidence has already shown that FTR is an underestimated factor in perioperative medicine accounting for or at least being involved in the development of postoperative mortality. While the incidence of severe postoperative complications amazingly does not show much variation between hospitals, FTR shows significant differences implying a major potential for improvement. With 14 million surgical procedures per year in Germany, a postoperative mortality of approximately 1% and an avoidable FTR rate of 40% mean that there are an estimated 60,000 preventable deaths per year. Hence, in the future it will be imperative to (1) identify patients at risk, (2) to prevent the development of postoperative complications with the use of adequate adjunctive therapeutic strategies, (3) to establish surveillance and monitoring systems for the early detection of postoperative complications and (4) to treat postoperative complications efficiently and in time when they arise.
尽管在过去几十年中，麻醉相关死亡率已显著降低至0.00068%-0.00082%，但最近的研究显示围手术期死亡率仍高达0.8%-4%。除了麻醉和手术引起的严重并发症外，围手术期死亡率主要受到患者个体合并症的负面影响。这些风险因素易引发急性危急事件（如心肌梗死）；然而，大多数致命并发症是由缓慢进展的疾病导致的，尤其是感染或全身炎症的后遗症。这意味着在检测和治疗缓慢发生的并发症以改善围手术期结局方面存在很大的机会窗口。“未能挽救”（FTR）这一术语，即死于严重并发症的患者比例与所有发生并发症患者数量之比，已被引入作为围手术期护理质量的有效指标。越来越多的证据表明，FTR是围手术期医学中一个被低估的因素，它在术后死亡率的发生中起作用或至少与之相关。虽然严重术后并发症的发生率在不同医院之间惊人地没有太大差异，但FTR却有显著差异，这意味着有很大的改进潜力。在德国，每年有1400万例外科手术，术后死亡率约为1%，可避免的FTR率为40%，这意味着每年估计有6万例可预防的死亡。因此，未来必须（1）识别高危患者，（2）通过使用适当的辅助治疗策略预防术后并发症的发生，（3）建立监测和监控系统以早期发现术后并发症，以及（4）在术后并发症出现时及时有效地进行治疗。
