Irita K, Kawashima Y, Kobayashi T, et al. Perioperative mortality and morbidity for the year of 1999 in 466 Japanese Certified Anesthesia-training Hospitals: with special reference to ASA-physical status-report of Committee on Operating Room Safety of Japan Society of Anesthesiologists. Masui 2001;50:676-691
Perioperative mortality and morbidity in Japan for the year 1999 were studied retrospectively. Committee on Operating Room Safety of the Japan Society of Anesthesiologists (JSA) sent confidential questionnaires to 774 Certified Training Hospitals of JSA and received answers from 60.2% of the hospitals. We analyzed their answers with special reference to ASA physical status (ASA-PS). The total number of anesthetics analyzed was 655, 644. Mortality and morbidity due to all kinds of causes including anesthetic management, intraoperative events, co-existing diseases, and operation were as follows. The incidence of cardiac arrest (per 10,000 anesthetics) was 0.68, 3.76, 14.37, 67.03, 0.36, 4.68, 27.96, 206.30 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The incidences of critical events including cardiac arrest, severe hypotension, and severe hypoxemia were 8.93, 26.99, 71.30, 188.52, 8.68, 31.27, 136.16, and 790.92 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The mortality rates (death during anesthesia and within 7th postoperative day) after cardiac arrest were 0.16, 0.94, 5.71, 33.51, 0.00, 1.46, 16.41 and 167.76 per 10,000 anesthetics in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The overall mortality rates were 0.24, 1.66, 12.16, 67.03, 0.00, 3.51, 34.65 and 417.14 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. Overall mortality and morbidity were higher in emergency anesthetics than in elective anesthetics. ASA-PS correlated well with overall mortality and with morbidity, regardless of etiology. The incidences of cardiac arrest totally attributable to anesthesia were 0.24, 0.45, 1.47, 8.38, 0.36, 1.75, 2.43 and 11.34 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The incidences of all critical events totally attributable to anesthesia were 4.92, 8.81, 14.74, 20.95, 4.34, 11.40, 15.80 and 22.67 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The mortality rates after cardiac arrest totally attributable to anesthesia were 0.00, 0.00, 0.61 and 4.53 in patients with ASA-PS of I-IV, I E-II E, III E, and IV E, respectively. The overall mortality rates totally attributable to anesthesia were 0.00, 0.04, 0.18, 0.00, 0.00, 0.61 and 4.53 in patients classified to ASA-PS of I, II, III, IV, I E-II E, III E, and IV E, respectively. Only one death, due to overdose of anesthetics, was reported among patients with good physical status (ASA-PS of I, II, II E and II E). Anesthetic management was mainly responsible for critical events in patients with good physical status, while co-existing diseases were in those with poor physical status. The major co-existing diseases or conditions leading to critical events were heart diseases in elective anesthetics, and hemorrhagic shock in emergency anesthetics. We reconfirmed that ASA-PS is beneficial to predict perioperative mortality and morbidity. It also seems likely that we should make much more efforts to reduce anesthetic morbidity in patients with good physical status, and to improve preanesthetic assessment and preparation of cardiovascular conditions in those with poor physical status.
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ABSTRACT: The 793 847 anesthesia cases collected from 460 anesthesia training hospitals in Japan in 1999 were analyzed. The incidences of cardiac arrest, other critical events (for example, severe hypotension or hypoxemia), and death from any cause were 6.53, 26.53, and 7.19 per 10 000 anesthesias, respectively. The incidences of these events attributable to the anesthetic procedure were 0.78, 6.71, and 0.13, respectively. Among the four major categories of principal causes of incidents, the outcome was worst for those due to preoperative complication, followed by those due to intraoperative events, then those due to surgery. The best prognosis was found for incidents due to anesthetic procedure. The rates of cardiac arrest and death totally attributable to anesthesia in Japan are comparable to those of other developed countries. To further improve anesthesia-related mortality and morbidity, we should pay more attention to improving preanesthetic assessment and preparation for cardiovascular conditions, in addition to being vigilant to avoid human errors.
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ABSTRACT: The risks and benefits of surgery for colorectal cancer in old patients have not been unequivocally defined. The present investigation was carried out in 309 hospitals as a prospective multicenter study. In the period between 1 January 2000 and 31 December 2001, a total of 19,080 patients were recruited for the study; 16,142 (84.6%) patients were younger than 80 years (<80) and 2932 (15.4%) were 80 years and older (> or =80). Significant differences between the age groups were observed for general postoperative complications (22.3% for <80 years; 33.9% for > or =80). Specific postoperative complications were identical in both groups. Overall, significantly elevated morbidity and mortality rates were found with increasing age (morbidity: 33.9% vs. 43.5%; mortality: 2.6% vs. 8.0%). The distribution of tumor stages revealed a significantly higher percentage of locally advanced tumors in the older age group (stage II: 28.0% vs. 34.4%). In contrast, no increase in metastasizing tumors was found in the older age group (stage IV: 17.4% vs. 14.1%). Logistic regression showed that, in concert with a number of other parameters, age is a significant influencing factor on postoperative morbidity and mortality. The increase in postoperative morbidity and mortality rates associated with aging is a result of the increase in general postoperative complications, in particular, pneumonia and cardiovascular complications. Age as such does not represent a contraindication for surgical treatment. The short-term outcome and quality of life are of overriding importance for the geriatric patient.
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ABSTRACT: La epidemiología de la mortalidad y de la morbilidad en anestesia engloba cuatro conceptos: la mortalidad, la morbilidad, su relación con la anestesia y también el análisis de las causas desencadenantes, favorecedoras o simplemente asociadas a estos eventos. Aunque la mortalidad apenas plantea problemas de definición, la morbilidad es un concepto más complejo. Puede englobar aspectos muy especiales como, por ejemplo, las cefaleas posraquianestesia o las náuseas y vómitos postoperatorios. El enfoque más seguro plantea la morbilidad de forma más global, clasificándola por orden creciente de gravedad y de frecuencia, y la cuestión de las complicaciones «pertinentes» respecto a la evolución de los pacientes es fundamental para mejorar la seguridad anestésica. La evolución de la epidemiología de la mortalidad y de la morbilidad sirve de fundamento y de guía a la lógica de las intervenciones realizadas en aras de la seguridad anestésica. De este modo, recientemente se han realizado dos estudios extensos en Francia que han permitido ilustrar la pertinencia de modificaciones amplias de las prácticas profesionales realizadas basándose en las conclusiones del primer estudio. Esta cuestión de la disminución de la mortalidad anestésica con el paso del tiempo siempre ha sido el objeto de debates alimentados por dos tipos de argumentos. El primero consiste en la dificultad que existe para comparar los estudios de metodologías diferentes y, sobre todo, realizados en períodos distintos. Aunque se debe ser prudente a la hora de comparar los resultados de estos estudios, hay que señalar que esta problemática sigue siendo una constante en el seguimiento de los indicadores de la seguridad de los sistemas. El segundo tipo de argumentos está relacionado con la confusión existente entre la disminución de la mortalidad y la evolución de la seguridad anestésica. Aunque las tasas de fallecimientos relacionados con la anestesia no correlacionan directamente con el nivel de seguridad, es razonable pensar que, en los últimos años, la disminución de la mortalidad anestésica se relaciona con una mejora de la seguridad.
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