Anesthesia interventions that alter perioperative mortality: a scoping review

Abstract

BackgroundWith over 230 million surgical procedures performed annually worldwide, better application of evidence in anesthesia and perioperative medicine may reduce widespread variation in clinical practice and improve patient care. However, a comprehensive summary of the complete available evidence has yet to be conducted. This scoping review aims to map the existing literature investigating perioperative anesthesia interventions and their potential impact on patient mortality, to inform future knowledge translation and ultimately improve perioperative clinical practice.MethodsSearches were conducted in MEDLINE, EMBASE, CINAHL, and the Cochrane Library databases from inception to March 2015. Study inclusion criteria were adult patients, surgical procedures requiring anesthesia, perioperative intervention conducted/organized by a professional with training in anesthesia, randomized controlled trials (RCTs), and patient mortality as an outcome. Studies were screened for inclusion, and data was extracted in duplicate by pairs of independent reviewers. Data were extracted, tabulated, and reported thematically.ResultsAmong the 10,505 publications identified, 369 RCTs (n = 147,326 patients) met the eligibility criteria. While 15 intervention themes were identified, only 7 themes (39 studies) had a significant impact on mortality: pharmacotherapy (n = 23), nutritional (n = 3), transfusion (n = 4), ventilation (n = 5), glucose control (n = 1), medical device (n = 2), and dialysis (n = 1).ConclusionsBy mapping intervention themes, this scoping review has identified areas requiring further systematic investigation given their potential value for reducing patient mortality as well as areas where continued investment may not be cost-effective given limited evidence for improving survival. This is a key starting point for future knowledge translation to optimize anesthesia practice.Electronic supplementary materialThe online version of this article (10.1186/s13643-018-0863-x) contains supplementary material, which is available to authorized users.

Sex/gender and additional equity characteristics of providers and patients in perioperative anesthesia trials: a cross-sectional analysis of the literature

“…A final possible limitation is that relevant studies may have not been included, despite conducting a rigorous and standardized search of the literature [ 28 ]. If mortality terms were not mentioned in the title or abstract of a study, they would not have been included due to the literature search and screening process.…”

“…This study conducted a cross-sectional secondary analysis of the original data set of 369 RCTs from our previously completed scoping review of anesthesia-related interventions that impact surgical patient mortality [ 28 ]. Details can be found elsewhere [ 28 ], in supplementary data. In brief, RCTs were retrieved from the following electronic databases: MEDLINE, Embase, CINAHL, CENTRAL, and the Cochrane Database of Systematic Reviews.…”

Guidelines on the intraoperative transfusion of red blood cells: a protocol for systematic review

“…This systematic review will allow for identification, appraisal and summary of literature devoted to the guidance of intraoperative allogenic RBC transfusion. The Perioperative Anesthesia Clinical Trials Group (PACT) identified transfusion as one of seven themes that has a significant impact on mortality, reinforcing the importance of this review 60. The results of this review will provide rationale and justification for development of guidance or the need for prospective evaluation of various intraoperative transfusion strategies.…”

Correction to: Anesthesia interventions that alter perioperative mortality: a scoping review

“…In the original publication of this article [ 1 ], Cole Etherington’s name was incorrectly captured as Nicole Etherington. The original article has been corrected.…”