Suán C, Pérez-Torres C, Herrera A
Servicio de Anestesiología, Reanimación y Terapia del Dolor, Hospital Universitario Virgen del Rocío, Sevilla.
Rev Esp Anestesiol Reanim. 1997 Aug-Sep;44(7):267-72.
To compare the postoperative mortality of our hospital to that of others.
Retrospectively, we studied patients who died after surgery in 1994, defining postoperative mortality as death occurring in the hospital after surgery. The variables studied were age, sex, preoperative disease, ASA, type of surgery, anesthetic technique, intraoperative complications and place, cause and time of death.
One hundred six (1.63%) of the 6,485 surgical patients died. The highest proportion were cardiovascular surgery patients (3.36%) and the smallest proportion (0%) had undergone eye surgery. Of patients receiving general anesthesia 2.16% died, while 0.59% of those receiving local-regional anesthesia did so. Most of those who died were male (55.66%); were over 55 years of age (87.73%); were ASA IV (67.03%); had associated medical disease (79.24%), mainly arterial hypertension; or had undergone emergency surgery (54.71%). Most who died had received general anesthesia (87.73%). Half of all deaths occurred in patients who presented some type of complication during surgery; this was the case with all who received intradural anesthesia, in 47.89% of those who had received general anesthesia and 20% of those receiving local anesthesia. The most common intraoperative complication in all anesthetic techniques was post-induction arterial hypotension. Over half of deaths occurred on the ward, after the first postoperative week, and the most frequent cause of death was sepsis (19.81%). We considered a death occurring on the hospital ward within the first 24 hours after surgery as possibly being associated with anesthesia (1.54/10,000).
Risk factors for postoperative mortality established in other studies (advanced age, male sex, emergency surgery and ASA IV-V) were relevant in most of the deaths studied. Our mortality rate is similar to that reported by other authors for the first 24 to 48 hours after surgery, but is higher 30 days after surgery and later. Some of the 13 patients who died on the hospital ward in the first 48 hours after surgery probably did not receive the care that would have been provided in the postoperative intensive care unit.
比较我院与其他医院的术后死亡率。
我们回顾性研究了1994年术后死亡的患者，将术后死亡率定义为术后在医院内发生的死亡。所研究的变量包括年龄、性别、术前疾病、美国麻醉医师协会（ASA）分级、手术类型、麻醉技术、术中并发症以及死亡地点、原因和时间。
6485例手术患者中有106例（1.63%）死亡。心血管手术患者的死亡比例最高（3.36%），而眼科手术患者的死亡比例最低（0%）。接受全身麻醉的患者中有2.16%死亡，而接受局部区域麻醉的患者中有0.59%死亡。大多数死亡患者为男性（55.66%）；年龄超过55岁（87.73%）；ASA分级为IV级（67.03%）；患有相关内科疾病（79.24%），主要为动脉高血压；或接受了急诊手术（54.71%）。大多数死亡患者接受了全身麻醉（87.73%）。所有死亡患者中有一半在手术期间出现了某种类型的并发症；接受硬膜内麻醉的患者全部如此，接受全身麻醉的患者中有47.89%，接受局部麻醉的患者中有20%。所有麻醉技术中最常见的术中并发症是诱导后动脉低血压。超过一半的死亡发生在病房，术后第一周之后，最常见的死亡原因是败血症（19.81%）。我们认为术后24小时内在医院病房发生的死亡可能与麻醉有关（1.54/10000）。
其他研究确定的术后死亡危险因素（高龄、男性、急诊手术和ASA IV - V级）在大多数所研究的死亡病例中都很重要。我们的死亡率在术后最初24至48小时与其他作者报道的相似，但在术后30天及以后更高。在术后48小时内在医院病房死亡的13例患者中，一些患者可能没有得到术后重症监护病房本应提供的护理。
