Abstract
BackgroundLittle information is known about factors that influence perioperative and anesthesia-related cardiac arrest (CA) in older patients. This study evaluated the incidence, causes and outcome of intraoperative and anesthesia-related CA in older patients in a Brazilian teaching hospital between 1996 and 2010.MethodsDuring the study, older patients received 18,367 anesthetics. Data collected included patient characteristics, surgical procedures, American Society of Anesthesiologists (ASA) physical status, anesthesia type, medical specialty team and outcome. All CAs were categorized by cause into one of four groups: patient's disease/condition-related, surgery-related, totally anesthesia-related or partially anesthesia-related.ResultsAll intraoperative CAs and deaths rates are shown per 10,000 anesthetics. There were 100 CAs (54.44; 95% confidence intervals [CI]: 44.68–64.20) and 68 deaths (37.02; 95% CI: 27.56–46.48). The majority of CAs were patient's disease-/condition-related (43.5; 95% CI: 13.44–73.68). There were six anesthesia-related CAs (3.26; 95% CI: 0.65–5.87) - 1 totally and 5 partially anesthesia-related, and three deaths, all partially anesthesia-related (1.63; 95% CI: 0.0–3.47). ASA I-II physical status patients presented no anesthesia-related CA. Anesthesia-related CA, absent in the last five years of the study, was due to medication-/airway-related causes. ASA physical status was the most important predictor of CA (odds ratio: 14.52; 95% CI: 4.48–47.08; P<0.001) followed by emergency surgery (odds ratio: 8.07; 95% CI: 5.14–12.68; P<0.001).ConclusionsThe study identified high incidence of intraoperative CAs with high mortality in older patients. The large majority of CAs were caused by factors not anesthesia-related. Anesthesia-related CA and mortality rates were 3.26 and 1.63 per 10,000 anesthetics, with no anesthesia-related CA in the last five years of the study. Major predictors of intraoperative CAs were poorer ASA physical status and emergency surgery. All anesthesia-related CAs were medication-related or airway-related, which is important for prevention strategies.
Highlights
One hundred cardiac arrest (CA) (54.44 per 10,000 anesthetics; 95% confidence interval (CI): 44.68–64.20) and 68 deaths (37.02 per 10,000 anesthetics; 95% CI: 27.56–46.48) were identified within the intraoperative period (OR and postanesthesia care unit (PACU))
The intraoperative CA and death incidence in older surgical patients increased with the American Society of Anesthesiologists (ASA) physical status classification, in emergency surgery (12:1 compared with elective surgery) (Table 1)
General anesthesia (6.6:1 compared with neuroaxial anesthesia) and an older patient’s disease/condition were important factors of intraoperative CA (13.4:1 compared with anesthesia and 5.7:1 compared with surgery) and death (Tables 2 and 3, respectively)
Summary
According to the World Health Organization, people $60 years old in developing countries, such as Brazil, are considered elderly [1]. Few studies on perioperative cardiac arrest (CA) and mortality carried out exclusively in geriatric patients undergoing all types of surgery have been published [3,4,5,6]. There are no studies on anesthesia-related CA and death exclusively in elderly patients. Little information is known about factors that influence intraoperative and anesthesia-related CA and death in older surgical patients. Little information is known about factors that influence perioperative and anesthesia-related cardiac arrest (CA) in older patients. This study evaluated the incidence, causes and outcome of intraoperative and anesthesia-related CA in older patients in a Brazilian teaching hospital between 1996 and 2010
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