Anaesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anaesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Brazil.
Shaare Zedek Medical Centre, Jerusalem, Israel; Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem, Israel.
J Clin Anesth. 2021 May;69:110160. doi: 10.1016/j.jclinane.2020.110160. Epub 2020 Dec 15.
Older patients have a higher probability of developing major complications during the perioperative period than other adult patients. Perioperative mortality depends on not only on a patient condition but also on the quality of perioperative care provided. We tested the hypothesis that the perioperative mortality rate among older patients has decreased over time and is related to a country's Human Development Index (HDI) status.
A systematic review with a meta-regression and meta-analysis of observational studies that reported perioperative mortality rates in patients aged ≥60 years was performed. We searched the PubMed, EMBASE, LILACS and SciELO databases from inception to December 30, 2019.
Mortality rates up to the seventh postoperative day were evaluated.
We evaluated the quality of the included studies. Perioperative mortality rates were analysed by time, country HDI status and baseline American Society of Anesthesiologists (ASA) physical status using meta-regression. Perioperative mortality and ASA status were analysed in low- and high-HDI countries during two time periods using proportion meta-analysis.
We included 25 studies, which reported 4,412,100 anaesthesia procedures and 3568 perioperative deaths from 12 countries. Perioperative mortality rates in high-HDI countries decreased over time (P = 0.042). When comparing pre-1990 to 1990-2019, in high-HDI countries, the perioperative mortality rates per 10,000 anaesthesia procedures decreased 7.8-fold from 100.85 (95% CI 43.36 to 181.72) in pre-1990 to 12.98 (95% CI 6.47 to 21.70) in 1990-2019 (P < 0.0001). There were no studies from low-HDI countries pre-1990. In the period from 1990 to 2019, perioperative mortality rates did not differ between low- and high-HDI countries (P = 0.395) but the limited number of patients in low-HDI countries impaired the result. Perioperative mortality rates increased with increasing ASA status (P < 0.0001). There were more ASA III-V patients in high-HDI countries than in low-HDI countries (P < 0.0001), and the perioperative mortality rate increased 24-fold in ASA III-V patients compared with ASA I-II patients (P < 0.0001).
The perioperative mortality rates in older patients have declined over the past 60 years in high-DHI countries, highlighting that perioperative safety in this population is increasing in these countries. Since data prior to 1990 were lacking in low-HDI countries, the evolution of their mortality rates could not be analysed. The perioperative mortality rate was similar in low- and high-HDI countries in the post-1990 period, but the low number of patients in the low-HDI countries does not allow a definitive conclusion.
与其他成年患者相比，老年患者在围手术期发生重大并发症的可能性更高。围手术期死亡率不仅取决于患者的病情，还取决于提供的围手术期护理质量。我们检验了这样一个假设，即老年患者的围手术期死亡率随着时间的推移而降低，并且与一个国家的人类发展指数（HDI）状况有关。
对报告≥60 岁患者围手术期死亡率的观察性研究进行了系统评价和荟萃回归及荟萃分析。我们从开始到 2019 年 12 月 30 日在 PubMed、EMBASE、LILACS 和 SciELO 数据库中进行了检索。
评估了术后 7 天内的死亡率。
我们评估了纳入研究的质量。使用荟萃回归分析了不同时间、国家 HDI 状况和基线美国麻醉医师协会（ASA）身体状况的围手术期死亡率。使用比例荟萃分析在两个时期分析了低和高 HDI 国家的围手术期死亡率和 ASA 状况。
我们纳入了 25 项研究，这些研究报告了来自 12 个国家的 4412100 例麻醉程序和 3568 例围手术期死亡。高 HDI 国家的围手术期死亡率随着时间的推移而降低（P=0.042）。在比较 1990 年前和 1990-2019 年期间，在高 HDI 国家中，每 10000 例麻醉手术的围手术期死亡率降低了 7.8 倍，从 1990 年前的 100.85（95%CI 43.36-181.72）降至 1990-2019 年的 12.98（95%CI 6.47-21.70）（P<0.0001）。低 HDI 国家没有 1990 年前的数据。在 1990 年至 2019 年期间，低和高 HDI 国家之间的围手术期死亡率没有差异（P=0.395），但低 HDI 国家患者数量有限，影响了结果。围手术期死亡率随 ASA 状态的增加而增加（P<0.0001）。高 HDI 国家的 ASA III-V 患者多于低 HDI 国家（P<0.0001），与 ASA I-II 患者相比，ASA III-V 患者的围手术期死亡率增加了 24 倍（P<0.0001）。
在过去的 60 年里，高 HDI 国家老年患者的围手术期死亡率有所下降，这表明该人群的围手术期安全性在这些国家正在提高。由于低 HDI 国家缺乏 1990 年前的数据，因此无法分析其死亡率的演变。在 1990 年后，低和高 HDI 国家的围手术期死亡率相似，但低 HDI 国家的患者数量较少，无法得出明确的结论。
