Risk factors of perioperative death at a university hospital in Thailand: a registry of 50,409 anesthetics

Abstract

Background: As a site of the Thai Anesthesia Incidents Study (THAI Study) of anesthetic adverse outcome, we continued the institutional data collection to determine incidence of cardiac arrest, mortality rate and risk factors representing a Thai University hospital. Methods: Between July 2003 and December 2006, an anesthesia registry was conducted at King Chulalongkorn Memorial Hospital. Anesthesiologists were requested to record perioperative variables and adverse outcomes including perioperative mortality (i.e., event of death since the conduction of anesthesia until the end of 24-hour postoperative period) on a structured data-record form. Details of events were reviewed by three independent anesthesiologists who determined the causes by consensus. Logistic regression identified characteristics associated with mortality within 24-hr P < 0.05 that were considered significant. Results: Among 50,409 cases in the registry, 108 patients experienced perioperative cardiac arrest with 80 fatalities. The incidences of intraoperative, and 24-hr perioperative cardiac arrest were 10.32 and 21.42 per 10000 anesthetics with mortality rate of 48.1% and 74.0% respectively. Factors related to perioperative mortality were; higher ASA physical status [OR 5.92 (95%, CI 4.41-7.95)], emergency surgery [OR 2.48 (95%, CI 1.31-4.70)], intracranial surgery [OR 10.01 (95%, CI 3.35-29.9)] and use of desflurane [OR 6.64 (95 %, CI 2.68-16.4)]. Factors related to lower risk of mortality were: lower abdominal surgery [OR 0.32 (95%, CI 0.13-0.78)], and the use of nitrous oxide [OR 0.38 (95%, CI 0.003-0.19)]. Common characteristic of intraoperative death were: male gender, emergency traumatic condition, upper abdominal surgery. The most common cause of intraoperative death was exangination (60%). The incidence of anesthesia related mortality was 0.198 per 10,000. Conclusion: The incidence of intraoperative and 24-hr perioperative cardiac arrest was 10.3 and 21.4 per 10000 anesthetics with morality rate of 48.1% and 74.0% respectively. Improving emergency trauma facility may increase survival rates.