Key result
Perioperative cardiac arrest occurred in 1.63% of emergency surgery patients within 24 hours, with ASA physical status 5-6 strongly increasing risk (RR 33.98; 95% CI 23.09-49.98; P<0.001).
Why the study?
What is the incidence of and what factors are associated with perioperative cardiac arrest within 24 hours of anesthesia for emergency surgery?
Cohort (n=44,339)
No
What is the incidence of and what factors are associated with perioperative cardiac arrest within 24 hours of anesthesia for emergency surgery?
Relative Risk: 33.98 (95% CI 23.09–49.98)
p-value: p=<0.001
Perioperative cardiac arrest within 24 hours of emergency surgery occurs at a rate of 1.63% and is strongly driven by baseline patient severity, including high ASA physical status and preoperative shock.
Warrants heightened vigilance for cardiac arrest in high-ASA emergency surgery patients; observational data support risk stratification but leave causal questions open.
PURPOSE: To determine the incidence of and factors associated with perioperative cardiac arrest within 24 hours of receiving anesthesia for emergency surgery. PATIENTS AND METHODS: This retrospective cohort study was approved by the ethical committee of Maharaj Nakorn Chiang Mai Hospital, Thailand. We reviewed the data of 44,339 patients receiving anesthesia for emergency surgery during the period from January 1, 2003 to March 31, 2011. The data included patient characteristics, surgical procedures, American Society of Anesthesiologists (ASA) physical status classification, anesthesia information, location of anesthesia performed, and outcomes. Data of patients who had received topical anesthesia or monitoring anesthesia care were excluded. Factors associated with cardiac arrest were identified by univariate analyses. Multiple regressions for the risk ratio (RR) and 95% confidence intervals (CI) were used to determine the strength of factors associated with cardiac arrest. A forward stepwise algorithm was chosen at a P-value <0.05. RESULTS: The incidence (within 24 hours) of perioperative cardiac arrest in patients receiving anesthesia for emergency surgery was 163 per 10,000. Factors associated with 24-hour perioperative cardiac arrest in emergency surgery were age of 2 years or younger (RR =1.46, CI =1.03-2.08, P=0.036), ASA physical status classification of 3-4 (RR =5.84, CI =4.20-8.12, P<0.001) and 5-6 (RR =33.98, CI =23.09-49.98, P<0.001), the anatomic site of surgery (upper intra-abdominal, RR =2.67, CI =2.14-3.33, P<0.001; intracranial, RR =1.74, CI =1.35-2.25, P<0.001; intrathoracic, RR =2.35, CI =1.70-3.24, P<0.001; cardiac, RR =3.61, CI =2.60-4.99, P<0.001; and major vascular; RR =3.05, CI =2.22-4.18, P<0.001), respiratory or cardiovascular comorbidities (RR =1.95, CI =1.60-2.38, P<0.001 and RR =1.38, CI =1.11-1.72, P=0.004, respectively), and patients in shock prior to receiving anesthesia (RR =2.62, CI =2.07-3.33, P<0.001). CONCLUSION: The perioperative incidence of cardiac arrest within 24 hours of anesthesia for emergency surgery was high and associated with multiple factors such as young age (≤2 years old), cardiovascular and respiratory comorbidities, increasing ASA physical status classification, preoperative shock, and surgery site. Perioperative care providers, including surgeons, anesthesiologists, and nurses, should be prepared to manage promptly this high risk group of surgical patients.
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Punjasawadwong et al. (2014) conducted a cohort in Emergency surgery (n=44,339). ASA physical status classification of 5-6 vs. Lower ASA physical status was evaluated on perioperative cardiac arrest within 24 hours (RR 33.98, 95% CI 23.09-49.98, p=<0.001). Perioperative cardiac arrest occurred in 1.63% of emergency surgery patients within 24 hours, with ASA physical status 5-6 strongly increasing risk (RR 33.98; 95% CI 23.09-49.98; P<0.001).
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