Peri-operative cardiac arrests in Sweden 2013–2022: data analysis of incidence and trends

IF 7.5 1区 医学 Q1 ANESTHESIOLOGY
Anaesthesia Pub Date : 2024-08-09 DOI:10.1111/anae.16396
Malin Sunborger, Jan G. Jakobsson
{"title":"Peri-operative cardiac arrests in Sweden 2013–2022: data analysis of incidence and trends","authors":"Malin Sunborger,&nbsp;Jan G. Jakobsson","doi":"10.1111/anae.16396","DOIUrl":null,"url":null,"abstract":"<p>In Europe, out-of-hospital cardiac arrests have an annual incidence rate of 7–17/10,000 per capita and in-hospital cardiac arrests have an annual incidence rate of 15–28/10,000 hospital admissions [<span>1</span>]. The incidence of in-hospital cardiac arrests in Sweden is 16/10,000 hospital admissions [<span>2</span>]. We conducted a study assessing if the incidence of peri-operative cardiac arrest had decreased in Sweden from 2013 to 2022. We also assessed the association between 30-day mortality, patient characteristics and urgency of surgery. All patients aged ≥ 18 y experiencing peri-operative cardiac arrest in the Swedish Perioperative Register (SPOR) between January 2013 and June 2022 were included. Total number of surgical procedures with complete data for patients aged ≥ 18 y registered in SPOR from 2013 to 2022 was used as the denominator (n = 3,049,782).</p><p>The primary outcome was the incidence of peri-operative cardiac arrest in 2022 compared with 2013. Secondary outcomes were 30-day all-cause mortality and association of peri-operative cardiac arrest with patient characteristics and urgency. Descriptive and regression analysis was performed. In total, 749 patients (51.6% male, mean (SD) age 69 (17.4) y) experienced peri-operative cardiac arrest during the study period. Patient characteristics and urgency are presented in Table 1. Year was missing for 13 cases of peri-operative cases leaving 736 for analysis. This equates to an overall annual incidence of peri-operative cardiac arrest of 2.4/10,000 procedures (95%CI 2.2–2.6). There was no significant difference over the period studied: 2.9/10,000 procedures in 2013 vs. 1.8/10,000 procedures in 2022. The highest incidence of peri-operative cardiac arrest and highest 30-day mortality rate was seen in patients who underwent emergency surgeries (54%). Hip fracture surgery was the most common planned surgical intervention, (n = 120, 16%) during the study period, followed by abdominal surgery (n = 118, 16%). 30-day mortality following cardiac arrest was 48% and mortality rate was 1.2/10,000 procedures (95%CI 0.7–1.5). Odds ratio (OR) for 30-day mortality increased with age (65–80 y, OR 2.32 (95%CI 1.43–3.77), &gt; 80 y, OR 6.11 (95%CI 3.57–10.45)); ASA physical status 3–5 (OR 2.81 (95%CI 1.74–4.54)); and surgical urgency (emergent OR 2.89 (95%CI 1.85–4.51), immediate 9.20 (95%CI 4.80–17.65)) but showed no significant change over time when adjusted for co-factors.</p><p>The overall incidence of peri-operative cardiac arrest in Sweden among adult patients (2.4 per 10,000 procedures) is lower compared with previous studies which ranged between 3–7 per 10,000 [<span>3, 4</span>]. A recent UK study found incidence rates of 3.0–3.5 per 10,000 interventions [<span>4</span>]. In that cohort, however, patients from infancy up to age 18 y (n = 12%) were included in the study. The Royal College of Anaesthetists, in its updated National Audit project (NAP7), defined peri-operative cardiac arrest as <i>“the delivery of five or more compressions and/or defibrillation in a patient having a procedure under the care of an anaesthetist”</i> [<span>5</span>]. The SPOR register includes only peri-operative events and cardiac arrest during the recovery room stay. It should also be acknowledged that the available data did not include medical history, information about comorbidities nor any detailed information about the cardiac arrest. It is reassuring to see that peri-operative cardiac arrest incidence is in line with data from other register studies, which show mortality rates around 50–60% [<span>3</span>].</p>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":null,"pages":null},"PeriodicalIF":7.5000,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.16396","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Anaesthesia","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/anae.16396","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

In Europe, out-of-hospital cardiac arrests have an annual incidence rate of 7–17/10,000 per capita and in-hospital cardiac arrests have an annual incidence rate of 15–28/10,000 hospital admissions [1]. The incidence of in-hospital cardiac arrests in Sweden is 16/10,000 hospital admissions [2]. We conducted a study assessing if the incidence of peri-operative cardiac arrest had decreased in Sweden from 2013 to 2022. We also assessed the association between 30-day mortality, patient characteristics and urgency of surgery. All patients aged ≥ 18 y experiencing peri-operative cardiac arrest in the Swedish Perioperative Register (SPOR) between January 2013 and June 2022 were included. Total number of surgical procedures with complete data for patients aged ≥ 18 y registered in SPOR from 2013 to 2022 was used as the denominator (n = 3,049,782).

The primary outcome was the incidence of peri-operative cardiac arrest in 2022 compared with 2013. Secondary outcomes were 30-day all-cause mortality and association of peri-operative cardiac arrest with patient characteristics and urgency. Descriptive and regression analysis was performed. In total, 749 patients (51.6% male, mean (SD) age 69 (17.4) y) experienced peri-operative cardiac arrest during the study period. Patient characteristics and urgency are presented in Table 1. Year was missing for 13 cases of peri-operative cases leaving 736 for analysis. This equates to an overall annual incidence of peri-operative cardiac arrest of 2.4/10,000 procedures (95%CI 2.2–2.6). There was no significant difference over the period studied: 2.9/10,000 procedures in 2013 vs. 1.8/10,000 procedures in 2022. The highest incidence of peri-operative cardiac arrest and highest 30-day mortality rate was seen in patients who underwent emergency surgeries (54%). Hip fracture surgery was the most common planned surgical intervention, (n = 120, 16%) during the study period, followed by abdominal surgery (n = 118, 16%). 30-day mortality following cardiac arrest was 48% and mortality rate was 1.2/10,000 procedures (95%CI 0.7–1.5). Odds ratio (OR) for 30-day mortality increased with age (65–80 y, OR 2.32 (95%CI 1.43–3.77), > 80 y, OR 6.11 (95%CI 3.57–10.45)); ASA physical status 3–5 (OR 2.81 (95%CI 1.74–4.54)); and surgical urgency (emergent OR 2.89 (95%CI 1.85–4.51), immediate 9.20 (95%CI 4.80–17.65)) but showed no significant change over time when adjusted for co-factors.

The overall incidence of peri-operative cardiac arrest in Sweden among adult patients (2.4 per 10,000 procedures) is lower compared with previous studies which ranged between 3–7 per 10,000 [3, 4]. A recent UK study found incidence rates of 3.0–3.5 per 10,000 interventions [4]. In that cohort, however, patients from infancy up to age 18 y (n = 12%) were included in the study. The Royal College of Anaesthetists, in its updated National Audit project (NAP7), defined peri-operative cardiac arrest as “the delivery of five or more compressions and/or defibrillation in a patient having a procedure under the care of an anaesthetist” [5]. The SPOR register includes only peri-operative events and cardiac arrest during the recovery room stay. It should also be acknowledged that the available data did not include medical history, information about comorbidities nor any detailed information about the cardiac arrest. It is reassuring to see that peri-operative cardiac arrest incidence is in line with data from other register studies, which show mortality rates around 50–60% [3].

2013-2022 年瑞典围手术期心脏骤停:发病率和趋势数据分析。
在欧洲,院外心脏骤停的年人均发病率为 7-17/10,000,院内心脏骤停的年人均发病率为 15-28/10,000[1]。在瑞典,院内心脏骤停的发病率为 16/10,000[2]。我们进行了一项研究,评估瑞典围手术期心脏骤停的发生率从 2013 年到 2022 年是否有所下降。我们还评估了 30 天死亡率、患者特征和手术紧迫性之间的关联。2013年1月至2022年6月期间,瑞典围手术期登记册(SPOR)中所有年龄≥18岁、围手术期心脏骤停的患者均被纳入其中。以2013年至2022年在SPOR登记的年龄≥18岁的患者中数据完整的手术总数为分母(n = 3,049,782)。次要结果是30天全因死亡率以及围手术期心脏骤停与患者特征和紧急程度的关系。研究人员进行了描述性分析和回归分析。在研究期间,共有749名患者(51.6%为男性,平均(标清)年龄为69(17.4)岁)经历了围手术期心脏骤停。患者特征和紧急程度见表 1。有 13 例围手术期病例的年份缺失,剩下 736 例可用于分析。这相当于每年围手术期心脏骤停的总发生率为 2.4/10,000(95%CI 2.2-2.6)。研究期间没有明显差异:2013 年为 2.9/10,000,2022 年为 1.8/10,000。接受急诊手术的患者围手术期心脏骤停发生率最高,30天死亡率也最高(54%)。在研究期间,髋部骨折手术是最常见的计划手术干预(120 人,16%),其次是腹部手术(118 人,16%)。心脏骤停后 30 天的死亡率为 48%,死亡率为 1.2/10,000(95%CI 0.7-1.5)。30 天死亡率的比值比 (OR) 随年龄(65-80 岁,OR 2.32 (95%CI 1.43-3.77),80 岁,OR 6.11 (95%CI 3.57-10.45))、ASA 体力状态 3-5 (OR 2.81 (95%CI 1.74-4.54))和手术紧迫性(紧急 OR 2.89 (95%CI 1.85-4.51),立即 9.20 (95%CI 4. 80-17.65))而增加。瑞典成年患者围手术期心脏骤停的总体发生率(每 10,000 例手术中 2.4 例)低于之前的研究(每 10,000 例手术中 3-7 例)[3, 4]。英国最近的一项研究发现,每 10,000 例介入手术中的发生率为 3.0-3.5 例[4]。不过,在该研究中,婴儿期至 18 岁的患者(n = 12%)都被纳入研究范围。英国皇家麻醉师学院在其更新的国家审计项目(NAP7)中将围手术期心脏骤停定义为 "在麻醉师护理下进行手术的患者中进行五次或五次以上按压和/或除颤"[5]。SPOR 登记册仅包括围手术期事件和在恢复室停留期间发生的心脏骤停。还应承认的是,现有数据并不包括病史、合并症信息或任何有关心脏骤停的详细信息。令人欣慰的是,围手术期心脏骤停发生率与其他登记研究的数据一致,后者显示死亡率约为 50-60%[3]。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Anaesthesia
Anaesthesia 医学-麻醉学
CiteScore
21.20
自引率
9.30%
发文量
300
审稿时长
6 months
期刊介绍: The official journal of the Association of Anaesthetists is Anaesthesia. It is a comprehensive international publication that covers a wide range of topics. The journal focuses on general and regional anaesthesia, as well as intensive care and pain therapy. It includes original articles that have undergone peer review, covering all aspects of these fields, including research on equipment.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信