Abstract
ObjectivesDespite a long history of concerns regarding patient safety during clinical care, some patients undergoing thoracic surgery continue to experience adverse events (AEs). AEs are a major significant source of perioperative morbidity and mortality following thoracic surgery. This study analysed the causes, treatment and prognosis of perioperative AEs to provide a reference for further surgical safety.MethodsThe authors collected a total of 62,571 thoracic surgery anaesthesia records via the Anaesthesia Information Management System (AIMS) from 14 August 2006 to 14 August 2017 and obtained 150 cases of perioperative serious AEs from the “adverse events registration” subsystem. The related hospitalization data of the 150 patients were analysed, including anaesthesia, recovery room time, ICU records and follow-up outcomes. The causes of these AEs were classified as follows: events related to the patients’ pathogenic conditions(P); surgery-related factors(S); anaesthesia-related factors(A); and interactions between pathogenic, surgical and anaesthesia factors (P&S&A). We then analysed the main clinical manifestations, causes and treatment of these events.ResultsThe overall rate of perioperative AEs in thoracic surgery (n = 62,571) was 0.2%. Of these, 10.7% were.caused by P and 23.3% by A; neither cause led to patient death. S and P&S&A accounted for 55.3 and 10.7% of AEs, respectively; together, they accounted for 66%. Twelve patients with postoperative AEs caused by S or P&S&A died within 3 days (8% of 150 cases). A total of 33%(50/150) of patients experienced sudden cardiac arrest (SCA) and recovered successfully. Surgical massive haemorrhage (22%, 33/150) was reported as a predominant mortality-related outcome in this group, and 8 of the 12 deaths were caused by massive haemorrhage.ConclusionsThe rate of perioperative AEs after thoracic surgery was 0.2%. AEs must be identified and treated immediately. An important factor in anaesthesia-related events was respiratory management. Two major clinical manifestations of surgery-related events were cardiac arrest and massive haemorrhage. Cardiac arrest was the major factor contributing to AEs, but its adverse consequences could be avoided with timely discovery and proper treatment. Massive haemorrhage is a significant cause of mortality that can be prevented with a surgeon’s early diagnosis and appropriate interventions.
Highlights
Anaesthesia-related mortality rates and complications have declined considerably [1,2,3]
Anaesthesia is a special medical process during surgery, and perioperative adverse events often involve many factors, including the patient’s pre-existing illness, surgical trauma, stimulation and deprivation resulting from the operation, anaesthesia, and the operation itself
We collected a total of 62,571 thoracic surgery cases
Summary
Anaesthesia-related mortality rates and complications have declined considerably [1,2,3]. This decrease has been attributed to a variety of safety improvements, including new anaesthetic drugs, anaesthetic techniques, monitoring techniques and the development and widespread adoption of practice guidelines [1,2,3]. Some surgical patients may still suffer from unexpected events during hospitalization, especially during cardiac, thoracic, vascular, gastrointestinal, paediatric and orthopaedic surgery [4,5,6]. Anaesthesia is a special medical process during surgery, and perioperative adverse events often involve many factors, including the patient’s pre-existing illness, surgical trauma, stimulation and deprivation resulting from the operation, anaesthesia, and the operation itself. It is challenging for anaesthesiologists to rapidly diagnose and properly treat perioperative adverse events
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