Wang Yu, Wang Jie, Ye Xihong, Xia Rui, Ran Ran, Wu Yaohua, Chen Qinghong, Li Haopeng, Huang Shiqian, Shu Aihua, Yang Longqiu, Qin Bin, Dong WenLi, Xia Zhongyuan, Zhang Zongze, Wan Li, Peng Xiaohong, Liu Juying, Wang Zaiping, Wang Yanlin, Yin Peng, Chen Xiangdong, Yao Shanglong
Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, China.
Lancet Reg Health West Pac. 2023 May 15;37:100787. doi: 10.1016/j.lanwpc.2023.100787. eCollection 2023 Aug.
The mortality risk related to anaesthesia in China remains poorly characterized. The objective of this study was to evaluate the anaesthesia-related mortality in terms of its incidence, changes, causes and preventability in Hubei, China, between 2017 and 2021 using a series of annual surveys.
We prospectively collected information on patient, surgical, anaesthesia, and hospital characteristics for 9,391,669 anaesthesia procedures performed between 2017 and 2021 in 10 cities within Hubei Province, China. Anaesthesia-related death was defined as death that deemed to be entirely or partially attributable to anaesthesia, occurring within 24 h following anaesthesia administration. All fatalities were scrutinized consecutively to determine their root causes and preventability. The incidence and patterns of anaesthesia-related deaths were analysed from 2017 to 2021. A mixed-effects model with a Poisson link function was fitted to evaluate the city-level annual changes in risk-adjusted incidence of anaesthesia-related deaths.
600 cases of anaesthetic deaths occurred from 2017 to 2021, yielding an incidence of 6.4 per 100,000 anaesthesia procedures [95% confidence interval (95% CI): 5.9, 6.9], and most were preventable (71.3%). There was a significant decrease from 2017 to 2021, in the incidences of anaesthesia-related death across all patients, those with American Society of Anaesthesiologists physical status (ASAPS) ≥III, and those who had general anaesthesia, with a percentage reduction of 57.6%, 59.1%, and 55.9%, respectively. The risk-adjusted annual changes indicated significant downward trends for the incidence of anaesthetic mortality from 2017 to 2018, 2019, 2020, and 2021. For instance, the risk-adjusted annual changes for the anaesthetic mortality incidence from 2017 to 2021 was -2.5 (95% CI: -1.4, -4.7).
In this large, comprehensive database study conducted in Central China, the anaesthesia-related death incidence was 6.4 per 100,000. Notably, the incidence of anaesthesia-related deaths decreased between 2017 and 2021. However, further in-depth analysis is needed to understand the extent to which these trends represent a change in patient safety.
Innovation and optimization of perioperative respiratory system management strategy (Hubei Technological Innovation Special Fund, 2019ACA167).
中国与麻醉相关的死亡风险特征仍不明确。本研究的目的是通过一系列年度调查，评估2017年至2021年期间中国湖北省与麻醉相关的死亡率，包括其发生率、变化情况、原因及可预防性。
我们前瞻性地收集了2017年至2021年在中国湖北省10个城市进行的9391669例麻醉手术的患者、手术、麻醉和医院特征信息。麻醉相关死亡定义为在麻醉给药后24小时内发生的、被认为全部或部分归因于麻醉的死亡。对所有死亡病例进行连续审查，以确定其根本原因和可预防性。分析了2017年至2021年与麻醉相关死亡的发生率和模式。采用具有泊松连接函数的混合效应模型来评估城市层面与麻醉相关死亡的风险调整发生率的年度变化。
2017年至2021年发生600例麻醉死亡病例，发生率为每100000例麻醉手术6.4例[95%置信区间（95%CI）：5.9，6.9]，且大多数是可预防的（71.3%）。2017年至2021年，所有患者、美国麻醉医师协会身体状况（ASAPS）≥III级的患者以及接受全身麻醉的患者中，与麻醉相关的死亡发生率均显著下降，分别下降了57.6%、59.1%和55.9%。风险调整后的年度变化表明，2017年至2018年、2019年、2020年和2021年麻醉死亡率的发生率呈显著下降趋势。例如，2017年至2021年麻醉死亡率发生率的风险调整后年度变化为-2.5（95%CI：-1.4，-4.7）。
在这项在中国中部地区进行的大型综合数据库研究中，与麻醉相关的死亡发生率为每100000例6.4例。值得注意的是，2017年至2021年期间与麻醉相关的死亡发生率有所下降。然而，需要进一步深入分析，以了解这些趋势在多大程度上代表了患者安全的变化。
围手术期呼吸系统管理策略的创新与优化（湖北省技术创新专项基金，2019ACA167）
