Document Detail

Impact of anesthesia management characteristics on severe morbidity and mortality.
MedLine Citation:
PMID:  15681938     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Quantitative estimates of how anesthesia management impacts perioperative morbidity and mortality are limited. The authors performed a study to identify risk factors related to anesthesia management for 24-h postoperative severe morbidity and mortality. METHODS: A case-control study was performed of all patients undergoing anesthesia (1995-1997). Cases were patients who either remained comatose or died during or within 24 h of undergoing anesthesia. Controls were patients who neither remained comatose nor died during or within 24 hours of undergoing anesthesia. Data were collected by means of a questionnaire, the anesthesia and recovery form. Odds ratios were calculated for risk factors, adjusted for confounders. RESULTS: The cohort comprised 869,483 patients; 807 cases and 883 controls were analyzed. The incidence of 24-h postoperative death was 8.8 (95% confidence interval, 8.2-9.5) per 10,000 anesthetics. The incidence of coma was 0.5 (95% confidence interval, 0.3-0.6). Anesthesia management factors that were statistically significantly associated with a decreased risk were: equipment check with protocol and checklist (odds ratio, 0.64), documentation of the equipment check (odds ratio, 0.61), a directly available anesthesiologist (odds ratio, 0.46), no change of anesthesiologist during anesthesia (odds ratio, 0.44), presence of a full-time working anesthetic nurse (odds ratio, 0.41), two persons present at emergence (odds ratio, 0.69), reversal of anesthesia (for muscle relaxants and the combination of muscle relaxants and opiates; odds ratios, 0.10 and 0.29, respectively), and postoperative pain medication as opposed to no pain medication, particularly if administered epidurally or intramuscularly as opposed to intravenously. CONCLUSIONS: Mortality after surgery is substantial and an association was established between perioperative coma and death and anesthesia management factors like intraoperative presence of anesthesia personnel, administration of drugs intraoperatively and postoperatively, and characteristics of delivered intraoperative and postoperative anesthetic care.
M Sesmu Arbous; Anneke E E Meursing; Jack W van Kleef; Jaap J de Lange; Huub H A J M Spoormans; Paul Touw; Frans M Werner; Diederick E Grobbee
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Anesthesiology     Volume:  102     ISSN:  0003-3022     ISO Abbreviation:  Anesthesiology     Publication Date:  2005 Feb 
Date Detail:
Created Date:  2005-01-31     Completed Date:  2005-02-24     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  257-68; quiz 491-2     Citation Subset:  AIM; IM    
Julius Center for Patient Oriented Research, Dutch Association for Anesthesiology, Utrecht, The Netherlands.
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MeSH Terms
Anesthesia / adverse effects,  methods*,  statistics & numerical data
Case-Control Studies
Chi-Square Distribution
Cohort Studies
Confidence Intervals
Intraoperative Complications / epidemiology,  mortality*
Middle Aged
Monitoring, Intraoperative / methods,  mortality*
Odds Ratio
Prospective Studies
Risk Factors
Statistics, Nonparametric
Comment In:
Anesthesiology. 2005 Feb;102(2):251-2   [PMID:  15681936 ]
Anesthesiology. 2006 Jan;104(1):202-3; author reply 204-5, 205-6   [PMID:  16394709 ]
Anesthesiology. 2006 Jan;104(1):203; author reply 204-5, 205-6   [PMID:  16394711 ]
Anesthesiology. 2006 Jan;104(1):203; author reply 204-5, 205-6   [PMID:  16394712 ]
Anesthesiology. 2006 Jan;104(1):204; author reply 205-6   [PMID:  16394714 ]
Anesthesiology. 2006 Jan;104(1):202; author reply 205-6   [PMID:  16394710 ]

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