Anesthesia-related mortality and morbidity
Bin Zhu, PUMC Hospital
To Err Is Human :
building a safer health system Report of IOM , Nov.1999
10000
20000
30000
40000
50000
60000
70000
80000
90000
100000
Medical Auto Workplace Air
How risky is the risk?
Mortality
数据被低估？
全球：
?手术后的并发症导致3-25%的患者残疾或延长住院时间；
?即每年至少有700万患者遭受术后并发症，而其中一半是可以预防的。
美国：
?美国的医疗不是传说中的那样安全。
?每年至少44,000和可能多达98,000病人由于本可避免的医疗差错而死于医院。
Anesthesia leads to adverse outcomes
Adverse outcomes are much more frequent ；anesthesia appears to be far from 99.99966% free of defects Morbidity in anesthesia: Today and tomorrow. Best Practice & Research Clinical Anaesthesiology 25 (2011) 123–132
Anesthesia related outcome
Pierce EC Jr: The 34th Rovenstine Lecture: 40 years behind the mask: Safety revisited.
but also include: quality of life ；
satisfaction for the patient.
Perioperative Mortality
1954 - 1989
1.3%
1980-2000
0.83%
CEPOD @
https://www.doczj.com/doc/c93393273.html,
Anesthesia was the primary cause in 1 in 2680 ; Surgery was the primary cause in 1 in 420 cases; Patient disease was the primary cause in 1 in 95 cases.
Perioperative Mortality
1999 - 20050.02%
Anesthesia complications were
?the underlying cause in 241 of these deaths (10.9%) ;
?contributing factor in the remaining 1,970 deaths (89.1%).
原因解析：
①麻醉药物过量
②麻醉药物不良反应
③产科麻醉问题
④气道丢失
Perioperative Cardiac Arrest
原因解析：
◆呼吸问题：气道丢失；中枢抑制
◆心脏问题（38%）：围术期心肌梗死
◆低血容量：绝对不足；相对不足
◆其它
Pathophysiologic description of main events leading to deaths totally and partially related to anesthesia.
Intraoperative Cardiac Arrest -1
数据库来源：the
主要结论（风险因素）：Surgeons National
主要结论(发生率和转归)：
Intraoperative cardiac arrest occurs
at a rate of approximately 7 per
10,000 noncardiac surgeries,
with a 30-day mortality rate of
63%；
Intraoperative Cardiac Arrest -2
what predict the mortality
Three independent predictors of mortality:
?patient comorbidity (relative risk, 16.116), ? cumulative deep hypnotic time (BIS <45) (relative risk, 1.244/hr),
?intraoperative systolic hypotension
(relative risk, 1.036/min).
“Triple Low” of Low MAP, Low BIS, and Low MAC Hospital Stay and Mortality.
Triple low: MAP <75 mmHg, BIS < 45, and MAC<0.8.
24,120 patients (>16 yr old) for noncardiac surgery at the Cleveland Clinic.
what predict the mortality
Anesthesiology,2012 Jun;116(6):1195-203
Lancet 2012; September,380: 1075–81
Lancet 2012; September, 380: 1075–81
Avoid the avoidable; Prevent the preventable 数据收集
整理分析
控制改进
So far, no national mortality survey.
The primary goal for Chinese Society
of Anesthesiology is to reduce the
anesthesia-attributed mortality to
“<1/10,000”
Who should be responsible?
ⅠWhen it is reasonably certain that the event or death was caused by the anesthetic agent or technique of administration or in other ways coming directly within the
anesthetist‘s province （基本就是）
ⅡSimilar to type I cases, but ones in which there is some element of doubt about whether the agent or technique was entirely responsible for the result （很可能）ⅢCases in which the patient‘s adverse event or death was caused by the anesthetic and the surgical technique （麻醉和外科导致）
ⅣEvents entirely referable to surgical technique（外科导致）
----Holland R:Br J Anaesth 59:834, 1987.
严格区分哪些M and M是麻醉相关没有意义，除非是科研或法律需要，应竭尽所能来降低所有M and M,而不只是麻醉直接相关的 M and M。