Aparicio MAI, Hernández PJM, Pérez ÁVB

Language: Spanish
References: 29
Page: 1-12
PDF size: 312.41 Kb.

ABSTRACT

Introduction: Perioperative mortality rate represents a global indicator for safe access to surgical and anesthesiological care.
Objective: To characterize patients who deceased during the perioperative period in surgical interventions.
Methods: A cross-sectional and descriptive study was carried out in the anesthesiology service of Arnaldo Milián Castro Clinical-Surgical Hospital, in Villa Clara Province, in the period from January 2015 to December 2018. The study population consisted of patients who received surgery within that hospital (N: 133 724). The sample consisted of patients who died during the intraoperative period and within the first 24 hours after surgery (n: 77).
Results: The general perioperative mortality rate was 5.76/10 000. There was incidence of higher mortality among men (59.7%), elderlies (75.3%), patients with several associated comorbidities (51.9%), those classified as ASA-IV (41.5%), those belonging to group II for surgical risk (62.3%), cases of abdominal surgery (63.6%), emergency interventions (88.3%), patients under general anesthetic technique (84.4 %), and at 24 hours after the postoperative period (68.8%). Septic shock was the main cause of mortality (48.1%).
Conclusions: There was a predominance of deaths among elderlies with associated comorbidities, high anesthetic, as well as surgical risk, who received emergency surgery under general anesthesia, being septic shock the main cause of death. The perioperative mortality rate was similar to that in nations of equivalent socioeconomic development.

REFERENCES

1. Eriksson LI, Wiener-Kronish JP, Cohen NH, Fleisher LA, Miller RD. Ámbito de la práctica anestésica moderna. En: Miller RD, Cohen NH, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Young WL, editor. Miller Anestesia. Octava ed. Madrid: Elsevier España; 2016. p. 2-9 e.1.

2. Neuman MD, Fleisher LA. Riesgo anestésico. En: Miller RD, Cohen NH, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Young WL, editor. Miller Anestesia. Octava ed. Madrid: Elsevier España; 2016. p. 1056-84. e5.

3. Gazoni FM, Amato PE, Malik ZM, Durieux ME. The impact of perioperative catastrophes on anesthesiologists: Results of a national survey. Anesthesia & Analgesia. 2012[acceso: 20/06/2018];114(3):596-603. Disponible en: https://journals.lww.com/anesthesia-analgesia/Fulltext/2012/03000/The_Impact_of_Perioperative_Catastrophes_on.17.aspx

4. Watters DA, Hollands MJ, Gruen RL, Maoate K, Perndt H, McDougall RJ, et al. Perioperative Mortality Rate (POMR): A Global Indicator of Access to Safe Surgery and Anaesthesia. World Journal of Surgery. 2015[acceso: 21/04/2019];39:856-64. Disponible en: http://prd-medweb-cdn.s3.amazonaws.com/documents/1anesthesiology/files/POMR.pdf

5. Wijeysundera DN, Sweitzer BJ. Evaluación preoperatoria. En: Miller RD, Cohen NH, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Young WL, editor. Miller Anestesia. Octava ed. Madrid: Elsevier España; 2016. p. 1085-155.

6. Sutton R, Bann S, Brooks M, Sarin S. The surgical risk scale as an improved tool for risk adjusted analysis in comparative surgical audit. British Journal of Surgery. 2002[acceso: 4/02/2017];89(6):763-8. Disponible en: https://doi.org/10.1046/j.1365-2168.2002.02080.x

7. Prodovic TT, Ristic BM, Vucetic DD, Ignjatovic-Ristic DI. The impact of gender differences on mortality in elderly patients after hip fracture. Vojnosanitetski Pregled. 2018;75(9):918-25. DOI: https://doi.org/10.2298/VSP161122022P

8. Berstock JR, Beswick AD, López López JA, Whitehouse MR, Blom AW. Mortality After Total Knee Arthroplasty. A Systematic Review of Incidence, Temporal Trends, and Risk Factors. The Journal of Bone and Joint Surgery. 2018;100:1064-70. DOI: https://dx.doi.org/10.2106/JBJS.17.00249

9. Raymond DP, Seder CW, Wright CD, Magee MJ, Kosinski AS, Cassivi SD, et al. Predictors of Major Morbidity or Mortality After Resection for Esophageal Cancer: A Society of Thoracic Surgeons General Thoracic Surgery Database Risk Adjustment Model. Annals of Thoracic Surgery. 2016:1-8. DOI: http://dx.doi.org/10.1016/j.athoracsur.2016.04.055

10. Suarez-de-la-Rica A, Castro-Arias C, Latorre J, Gilsanz F, Maseda E. Pronóstico y predictores de mortalidad de los pacientes ancianos críticos. Revista Española de Anestesiología y Reanimación. 2017. Disponible en: https://doi.org/10.1016/j.redar.2017.11.004

11. García PC, Mateo E, Hornero F, Cantero ML, Zarragoikoetxea I. Mortalidad de la cirugía coronaria aislada en octogenarios. Análisis restrospectivo de 14 años. Revista Española de Anestesiología y Reanimación. 2017[acceso: 28/04/2018];64(5):262-72. Disponible en: https://www.researchgate.net/profile/Eva_Mateo2/publication/314128496_Mortalidad_de_la_cirugia_coronaria_aislada_en_octogenarios_Analisis_restrospectivo_de_14_anos/links/59e44274aca2724cbfe5f396/Mortalidad-de-la-cirugia-coronaria-aislada-en-octogenarios-Analisis-restrospectivo-de-14-anos.pdf

12. Romero JAP, Borrell MC, Gómez LF, Delgado JAC. Morbimortalidad anestésica y sus factores de riesgo en pacientes con fractura de cadera. Revista Cubana de Anestesiología y Reanimación. 2016[acceso: 9/09/2018];15(3):235-42. Disponible en: http://scielo.sld.cu/pdf/scar/v15n3/scar07316.pdf

13. Martín DP, Piña MA, Martín FP, Domínguez SV, Vicente BV, Hernández PP, et al. Mortalidad hospitalaria en pacientes críticos postquirúrgicos mayores de 80 años. ¿Podemos predecirla de forma precoz? Revista Española de Anestesiología y Reanimación. 2015. DOI: http://dx.doi.org/10.1016/j.redar.2015.08.004

14. Sessler DI, Devereaux PJ. Perioperative troponin screening. Anesthesia & Analgesia. 2016[acceso: 20/06/2018];123(2):359-60. Disponible en: https://www.ingentaconnect.com/content/wk/ane/2016/00000123/00000002/art00011

15. Jørgensen CC, Madsbad S, Kehlet H. Postoperative morbidity and mortality in type-2 diabetics after fast-track primary total hip and knee arthroplasty. Anesthesia & Analgesia. 2015[acceso: 20/06/2018];120(1):230-8. Disponible en: https://journals.lww.com/anesthesia-analgesia/Fulltext/2015/01000/Postoperative_Morbidity_and_Mortality_in_Type_2.32.aspx

16. Fernández-Bustamante A, Frendl G, Sprung J, Kor DJ, Subramaniam B, Ruiz RM, et al. Posoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery. A Multicenter Study by the Perioperative Research Network Investigators. JAMA Surgery. 2017[acceso: 21/04/2019];152(2):157-66. Disponible en: http://jama.jamanetwork.com/article.aspx?doi=10.1001/jamasurg.2016.4065&utm_campaign=articlePDF%26utm_medium=articlePDFlink%26utm_source=articlePDF%26utm_content=jamasurg.2016.4065

17. Hackett NJ, Oliveira GSD, Jain UK, Kim JYS. ASA class is a reliable independent predictor of medical complications and mortality following surgery. International Journal of Surgery. 2015;18:184-90. DOI: http://dx.doi.org/10.1016/j.ijsu.2015.04.079

18. Jean RA, DeLuzio MR, Kraev AI, Wang G, Boffa DJ, Detterbeck FC, et al. Analyzing risk factors for morbidity and mortality after lung resection for lung cancer using the NSQIP Database. Journal of the American College of Surgeons. 2016;222(6):992-1001. DOI: https://doi.org/10.1016/j.jamcollsurg.2016.02.020

19. Lee JY, Lee SH, Jung MJ, Lee JG. Perioperative risk factors for in-hospital mortality after emergency gastrointestinal surgery. Medicine. 2016;95(35):1-5. DOI: http://dx.doi.org/10.1097/MD.0000000000004530

20. Stefani LC, Gamermann PW, Backof A, Guollo F, Borges RMJ, Martin A, et al. Perioperative mortality related to anesthesia within 48 h and up to 30 days following surgery: A retrospective cohort study of 11,562 anesthetic procedures. Journal of Clinical Anesthesia. 2018;49:79-86. DOI: https://doi.org/10.1016/j.jclinane.2018.06.025

21. Whitlock EL, Feiner JR, Chen Ll. Perioperative Mortality, 2010 to 2014. A Retrospective Cohort Study Using the National Anesthesia Clinical Outcomes Registry. Anesthesiology. 2015;123:1312-21. DOI: https://doi.org/10.1097/ALN.0000000000000882

22. Sabaté A, Gil-Bona J, Pia A, Adroer R, Jaurrieta E. Mortalidad perioperatoria de los pacientes quirúrgicos: estudio transversal retrospectivo de los pacientes fallecidos en el periodo 2004 a 2008 en un hospital terciario. Revista Española de Anestesiología y Reanimación. 2010[acceso: 10/03/2018];57:639-47. Disponible en: https://www.sciencedirect.com/science/article/pii/S0034935610703005

23. Belletti A, Benedetto U, Biondi-Zoccai G, Leggieri C, Silvani P, Angelini GD, et al. The effect of vasoactive drugs on mortality in patients with severe sepsis and septic shock. A network meta-analysis of randomized trials. Journal of Critical Care. 2017;37:91-8. DOI: http://dx.doi.org/10.1016/j.jcrc.2016.08.010

24. Vail E, Gershengorn HB, Hua M, J.Walkey A, Rubenfeld G, Wunsch H. Association Between US Norepinephrine Shortage and Mortality Among Patients With Septic Shock. JAMA. 2017[acceso: 21/04/2019];317(14):1433-42. Disponible en: http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2017.2841&utm_campaign=articlePDF%26utm_medium=articlePDFlink%26utm_source=articlePDF%26utm_content=jama.2017.2841

25. Rhodes A, Evans LE, Alhazzani W. Guía internacional para el manejo de la sepsis y el shock séptico. Care Med. 2017[acceso: 12/04/2019];45(3):486-552. Disponible en: http://www.richclinics.com/upload/201701/24/201701240837567434.pdf

26. Cannon JW. Hemorrhagic Shock. The New England Journal of Medicine. 2018[acceso: 20/06/2018];378(4):370-9. Disponible en: https://www.nejm.org/doi/full/10.1056/NEJMra1705649

27. Jahan S, Palanivel T, Kovacevic M, Assa J, Bonini A, Calderón C, et al. Índices e indicadores de desarrollo humano. Actualización estadística de 2018. Programa de las Naciones Unidas para el Desarrollo; 2019[acceso: 18/04/2019]. Disponible en: http://hdr.undp.org/sites/default/files/2018_human_development_statistical_update_es.pdf

28. Bainbridge D, Martin J, Arango M, Cheng D. Perioperative and anaesthetic-related mortality in developed and developing countries: a systematic review and meta-analysis. The Lancet. 2012;380:1075-81. DOI: https://doi.org/10.1016/S0140-6736(12)60990-8

29. Vallongo MB. Factores de riesgo de paro cardiaco intraoperatorio [Tesis]. Internet: Universidad de Ciencias Médicas de la Habana; 2013. Disponible en: http://tesis.sld.cu/index.php?P=DownloadFile&Id=90