Epidemiology of perioperative cardiac arrest and mortality in Brazil: a systematic review

Braz, Leandro Gobbo; Morais, Arthur Caus de; Sanchez, Rafael; Porto, Daniela de Sá Menezes; Pacchioni, Mariana; Serafim, Williany Dark Silva; Módolo, Norma Sueli Pinheiro; Nascimento, Paulo do; Braz, Mariana Gobbo; Bráz, José Reinaldo Cerqueira

doi:10.1016/j.bjane.2020.04.014

Cited by 2 publications

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“…The most influential cause of perioperative CA and mortality events in Brazilian studies was sepsis, followed by trauma [ 23 , 29 , 30 , 37 ]. Therefore, comorbid conditions seem to be major contributors to the high perioperative CA and mortality rates in Brazil [ 5 ]. Thus, preanesthetic management of comorbidities plays a major role in minimizing perioperative complications and adverse effects.…”

Section: Discussionmentioning

confidence: 99%

“…The rates of perioperative CA and mortality can be used to explore the differences among facilities that perform surgical and anesthesia procedures in different centers and can serve as quality indicators to promote improvements in patient safety and reductions in unfavorable outcomes [ 2 – 4 ]. Brazil is a developing country that, over the years, has experienced great difficulty in offering adequate healthcare to its population [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

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Perioperative and anesthesia-related cardiac arrest and mortality rates in Brazil: A systematic review and proportion meta-analysis

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Introduction Studies have shown that both perioperative and anesthesia-related cardiac arrest (CA) and mortality rates are much higher in developing countries than in developed countries. This review aimed to compare the rates of perioperative and anesthesia-related CA and mortality during 2 time periods in Brazil. Methods A systematic review with meta-analysis of full-text Brazilian observational studies was conducted by searching the Medline, EMBASE, LILACS and SciELO databases up to January 29, 2020. The primary outcomes were perioperative CA and mortality rates and the secondary outcomes included anesthesia-related CA and mortality events rates up to 48 postoperative hours. Results Eleven studies including 719,273 anesthetic procedures, 962 perioperative CAs, 134 anesthesia-related CAs, 1,239 perioperative deaths and 29 anesthesia-related deaths were included. The event rates were evaluated in 2 time periods: pre-1990 and 1990–2020. Perioperative CA rates (per 10,000 anesthetics) decreased from 39.87 (95% confidence interval [CI]: 34.60–45.50) before 1990 to 17.61 (95% CI: 9.21–28.68) in 1990–2020 (P < 0.0001), while the perioperative mortality rate did not alter (from 19.25 [95% CI: 15.64–23.24] pre-1990 to 25.40 [95% CI: 13.01–41.86] in 1990–2020; P = 0.1984). Simultaneously, the anesthesia-related CA rate decreased from 14.39 (95% CI: 11.29–17.86) to 3.90 (95% CI: 2.93–5.01; P < 0.0001), while there was no significant difference in the anesthesia-related mortality rate (from 1.75 [95% CI: 0.76–3.11] to 0.67 [95% CI: 0.09–1.66; P = 0.5404). Conclusions This review demonstrates an important reduction in the perioperative CA rate over time in Brazil, with a large and consistent decrease in the anesthesia-related CA rate; however, there were no significant differences in perioperative and anesthesia-related mortality rates between the assessed time periods.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Perioperative and anesthesia-related cardiac arrest and mortality rates in Brazil: A systematic review and proportion meta-analysis

et al. 2020

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“…The rate of peri-operative cardiac arrest related to SIRS/ sepsis is five-fold higher in low-HDI countries than in high-HDI countries [26,38,39].…”

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confidence: 98%

“…A recent study in a high‐HDI country revealed that baseline ASA 4–5 physical status and SIRS/sepsis were the most important risk‐factors for intra‐operative cardiac arrest and death [3]. The rate of peri‐operative cardiac arrest related to SIRS/sepsis is five‐fold higher in low‐HDI countries than in high‐HDI countries [26, 38, 39].…”

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confidence: 99%

Association between intra‐operative cardiac arrest and country Human Development Index status: a systematic review with meta‐regression analysis and meta‐analysis of observational studies^*

et al. 2021

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Summary Intra‐operative cardiac arrests differ from most in‐hospital cardiac arrests because they reflect not only the patient's condition but also the quality of surgery and anaesthesia care provided. We assessed the relationship between intra‐operative cardiac arrest rates and country Human Development Index (HDI), and the changes occurring in these rates over time. We searched PubMed, EMBASE, Scopus, LILACS, Web of Science, CINAHL and SciELO from inception to 29 January 2020. For the global population, rates of intra‐operative cardiac arrest and baseline ASA physical status were extracted. Intra‐operative cardiac arrest rates were analysed by time, country HDI status and ASA physical status using meta‐regression analysis. Proportional meta‐analysis was performed to compare intra‐operative cardiac arrest rates and ASA physical status in low‐ vs. high‐HDI countries and in two time periods. Eighty‐two studies from 25 countries with more than 29 million anaesthetic procedures were included. Intra‐operative cardiac arrest rates were inversely correlated with country HDI (p = 0.0001); they decreased over time only in high‐HDI countries (p = 0.040) and increased with increasing ASA physical status (p < 0.0001). Baseline ASA physical status did not change in high‐HDI countries (p = 0.106), while it decreased over time in low‐HDI countries (p = 0.040). In high‐HDI countries, intra‐operative cardiac arrest rates (per 10,000 anaesthetic procedures) decreased from 9.59 (95%CI 6.59–13.16) pre‐1990 to 5.17 (95%CI 4.42–5.97) in 1990–2020 (p = 0.013). During the same time periods, no improvement was observed in the intra‐operative cardiac arrest rates in low‐HDI countries (p = 0.498). Odds ratios of intra‐operative cardiac arrest rates in ASA 3–5 patients were 8.48 (95%CI 1.67–42.99) times higher in low‐HDI countries than in high‐HDI countries (p = 0.0098). Intra‐operative cardiac arrest rates are related to country‐HDI and decreased over time only in high‐HDI countries. The widening gap in these rates between low‐ and high‐HDI countries needs to be addressed globally.

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Epidemiology of perioperative cardiac arrest and mortality in Brazil: a systematic review

Cited by 2 publications

References 38 publications

Perioperative and anesthesia-related cardiac arrest and mortality rates in Brazil: A systematic review and proportion meta-analysis

Perioperative and anesthesia-related cardiac arrest and mortality rates in Brazil: A systematic review and proportion meta-analysis

Association between intra‐operative cardiac arrest and country Human Development Index status: a systematic review with meta‐regression analysis and meta‐analysis of observational studies^*

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Epidemiology of perioperative cardiac arrest and mortality in Brazil: a systematic review

Cited by 2 publications

References 38 publications

Perioperative and anesthesia-related cardiac arrest and mortality rates in Brazil: A systematic review and proportion meta-analysis

Perioperative and anesthesia-related cardiac arrest and mortality rates in Brazil: A systematic review and proportion meta-analysis

Association between intra‐operative cardiac arrest and country Human Development Index status: a systematic review with meta‐regression analysis and meta‐analysis of observational studies*

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Association between intra‐operative cardiac arrest and country Human Development Index status: a systematic review with meta‐regression analysis and meta‐analysis of observational studies^*