PDF(Pubmed)
Abstract：
BACKGROUND: The magnitude of the risk of death and cardiac arrest associated with emergency surgery and anesthesia is not well understood. Our aim was to assess whether the risk of perioperative and anesthesia-related death and cardiac arrest has decreased over the years, and whether the rates of decrease are consistent between developed and developing countries.
METHODS: A systematic review was performed using electronic databases to identify studies in which patients underwent emergency surgery with rates of perioperative mortality, 30-day postoperative mortality, or perioperative cardiac arrest. Meta-regression and proportional meta-analysis with 95% confidence intervals (CIs) were performed to evaluate global data on the above three indicators over time and according to country Human Development Index (HDI), and to compare these results according to country HDI status (low vs. high HDI) and time period (pre-2000s vs. post-2000s).
RESULTS: 35 studies met the inclusion criteria, representing more than 3.09 million anesthetic administrations to patients undergoing anesthesia for emergency surgery. Meta-regression showed a significant association between the risk of perioperative mortality and time (slope: -0.0421, 95%CI: from - 0.0685 to -0.0157; P = 0.0018). Perioperative mortality decreased over time from 227 per 10,000 (95% CI 134-380) before the 2000s to 46 (16-132) in the 2000-2020 s (p < 0-0001), but not with increasing HDI. 30-day postoperative mortality did not change significantly (346 [95% CI: 303-395] before the 2000s to 292 [95% CI: 201-423] in the 2000s-2020 period, P = 0.36) and did not decrease with increasing HDI status. Perioperative cardiac arrest rates decreased over time, from 113 per 10,000 (95% CI: 31-409) before the 2000s to 31 (14-70) in the 2000-2020 s, and also with increasing HDI (68 [95% CI: 29-160] in the low-HDI group to 21 [95% CI: 6-76] in the high-HDI group, P = 0.012).
CONCLUSIONS: Despite increasing baseline patient risk, perioperative mortality has decreased significantly over the past decades, but 30-day postoperative mortality has not. A global priority should be to increase long-term survival in both developed and developing countries and to reduce overall perioperative cardiac arrest through evidence-based best practice in developing countries.
METHODS: A systematic review was performed using electronic databases to identify studies in which patients underwent emergency surgery with rates of perioperative mortality, 30-day postoperative mortality, or perioperative cardiac arrest. Meta-regression and proportional meta-analysis with 95% confidence intervals (CIs) were performed to evaluate global data on the above three indicators over time and according to country Human Development Index (HDI), and to compare these results according to country HDI status (low vs. high HDI) and time period (pre-2000s vs. post-2000s).
RESULTS: 35 studies met the inclusion criteria, representing more than 3.09 million anesthetic administrations to patients undergoing anesthesia for emergency surgery. Meta-regression showed a significant association between the risk of perioperative mortality and time (slope: -0.0421, 95%CI: from - 0.0685 to -0.0157; P = 0.0018). Perioperative mortality decreased over time from 227 per 10,000 (95% CI 134-380) before the 2000s to 46 (16-132) in the 2000-2020 s (p < 0-0001), but not with increasing HDI. 30-day postoperative mortality did not change significantly (346 [95% CI: 303-395] before the 2000s to 292 [95% CI: 201-423] in the 2000s-2020 period, P = 0.36) and did not decrease with increasing HDI status. Perioperative cardiac arrest rates decreased over time, from 113 per 10,000 (95% CI: 31-409) before the 2000s to 31 (14-70) in the 2000-2020 s, and also with increasing HDI (68 [95% CI: 29-160] in the low-HDI group to 21 [95% CI: 6-76] in the high-HDI group, P = 0.012).
CONCLUSIONS: Despite increasing baseline patient risk, perioperative mortality has decreased significantly over the past decades, but 30-day postoperative mortality has not. A global priority should be to increase long-term survival in both developed and developing countries and to reduce overall perioperative cardiac arrest through evidence-based best practice in developing countries.
摘要：
背景：与急诊手术和麻醉相关的死亡和心脏骤停风险的大小尚不清楚。我们的目的是评估围手术期和与麻醉相关的死亡和心脏骤停的风险是否已经降低。以及发达国家和发展中国家之间的下降速度是否一致。
方法：使用电子数据库进行系统评价，以确定接受急诊手术的患者围手术期死亡率的研究，术后30天死亡率，或者围手术期心脏骤停.根据国家人类发展指数（HDI），进行具有95％置信区间（CI）的荟萃回归和比例荟萃分析，以评估上述三个指标随时间变化的全球数据。并根据国家HDI状况(低与高HDI)和时间段(2000年前与2000年代后）。
结果：35项研究符合纳入标准，代表超过309万个麻醉剂管理部门，用于接受急诊手术麻醉的患者。Meta回归显示围手术期死亡风险与时间之间存在显著关联（斜率：-0.0421，95CI：从-0.0685到-0.0157；P=0.0018）。随着时间的推移，围手术期死亡率从2000年代之前的227/10,000（95％CI134-380）下降到2000-2020年代的46（16-132）（p<0-0001），但不是随着HDI的增加。术后30天死亡率没有显着变化（2000年代之前的346[95％CI：303-395]到2000年代至2020年期间的292[95％CI：201-423]，P=0.36），并且不随HDI状态的增加而降低。围手术期心脏骤停率随着时间的推移而下降，从2000年前的每10000人中113人(95%CI：31-409)到2000-2020年的31人(14-70)，并且随着HDI的增加（低HDI组的68[95％CI：29-160]到高HDI组的21[95％CI：6-76]，P=0.012)。
结论：尽管基线患者风险增加，围手术期死亡率在过去几十年显著下降，但术后30天死亡率没有。全球优先事项应该是提高发达国家和发展中国家的长期生存率，并通过发展中国家的循证最佳实践减少整体围手术期心脏骤停。
方法：使用电子数据库进行系统评价，以确定接受急诊手术的患者围手术期死亡率的研究，术后30天死亡率，或者围手术期心脏骤停.根据国家人类发展指数（HDI），进行具有95％置信区间（CI）的荟萃回归和比例荟萃分析，以评估上述三个指标随时间变化的全球数据。并根据国家HDI状况(低与高HDI)和时间段(2000年前与2000年代后）。
结果：35项研究符合纳入标准，代表超过309万个麻醉剂管理部门，用于接受急诊手术麻醉的患者。Meta回归显示围手术期死亡风险与时间之间存在显著关联（斜率：-0.0421，95CI：从-0.0685到-0.0157；P=0.0018）。随着时间的推移，围手术期死亡率从2000年代之前的227/10,000（95％CI134-380）下降到2000-2020年代的46（16-132）（p<0-0001），但不是随着HDI的增加。术后30天死亡率没有显着变化（2000年代之前的346[95％CI：303-395]到2000年代至2020年期间的292[95％CI：201-423]，P=0.36），并且不随HDI状态的增加而降低。围手术期心脏骤停率随着时间的推移而下降，从2000年前的每10000人中113人(95%CI：31-409)到2000-2020年的31人(14-70)，并且随着HDI的增加（低HDI组的68[95％CI：29-160]到高HDI组的21[95％CI：6-76]，P=0.012)。
结论：尽管基线患者风险增加，围手术期死亡率在过去几十年显著下降，但术后30天死亡率没有。全球优先事项应该是提高发达国家和发展中国家的长期生存率，并通过发展中国家的循证最佳实践减少整体围手术期心脏骤停。
