Department of Surgical Sciences, Section of Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden.
Department of Surgical Sciences, Section of Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden; Uppsala Centre for Paediatric Anaesthesia and Intensive Care Research, Uppsala University Hospital, Uppsala, Sweden.
Br J Anaesth. 2024 Oct;133(4):804-809. doi: 10.1016/j.bja.2024.07.007. Epub 2024 Aug 1.
Centralisation of perioperative care for small children to a limited number of specialised paediatric centres has many theoretical advantages, but neither the optimal balance nor the current distribution of paediatric anaesthesia on a national scale are well elucidated. The aim of this study was to describe the distribution, adverse events, and mortality in children undergoing anaesthesia in Sweden.
In this cohort study, data from all paediatric anaesthesia procedures registered in Sweden during the years 2019-22 were extracted from the Swedish Perioperative Register (SPOR). Data were analysed according to hospital level of care and ASA physical status.
Data from 81 hospitals were analysed. During the 4-yr period, 214,964 procedures were registered. Most procedures in neonates and infants were managed in paediatric (73%) and other university hospitals (21%). Adverse events occurred in 2.71% of cases and severe adverse events in 0.067%. The all-cause 24-h mortality rate was 6.6:10,000 anaesthetics and the all-cause 30-day mortality was 14.7:10,000 anaesthetics. The 30-day all-cause estimated mortality was highest in paediatric hospitals (95% confidence interval [CI] 30-39) compared with other university hospitals (95% CI 6.1-12), county (95% CI 1.9-4.8), district (95% CI 0.07-2.2), and smaller hospitals (95% CI 0.0-22).
Most procedures in neonates and infants were performed in tertiary centres, with county hospitals managing mainly older children, in accordance with national recommendations. Mortality was more common in tertiary centres, reflecting increased comorbidity and centralisation of anaesthesia of neonates and infants.
将小儿围手术期护理集中到少数几家专门的儿科中心有许多理论上的优势，但最佳平衡状态以及全国范围内儿科麻醉的分布情况尚不清楚。本研究旨在描述在瑞典接受麻醉的儿童的分布情况、不良事件和死亡率。
在这项队列研究中，从瑞典围手术期注册中心（SPOR）中提取了 2019-2022 年期间所有小儿麻醉程序的数据。根据医院的护理水平和美国麻醉医师协会（ASA）的身体状况对数据进行分析。
分析了 81 家医院的数据。在 4 年期间，共登记了 214964 例手术。新生儿和婴儿的大多数手术都在儿科（73%）和其他大学医院（21%）进行。有 2.71%的病例发生了不良事件，有 0.067%的病例发生了严重不良事件。所有原因的 24 小时死亡率为 6.6:10000 麻醉，所有原因的 30 天死亡率为 14.7:10000 麻醉。30 天全因估计死亡率在儿科医院最高（95%置信区间[CI] 30-39），高于其他大学医院（95%CI 6.1-12）、县医院（95%CI 1.9-4.8）、地区医院（95%CI 0.07-2.2）和较小的医院（95%CI 0.0-22）。
新生儿和婴儿的大多数手术都在三级中心进行，县医院主要管理年龄较大的儿童，这符合国家的建议。死亡率在三级中心更为常见，这反映了新生儿和婴儿的合并症增加和麻醉集中化。
