Perioperative and anesthesia-related cardiac arrests in geriatric patients: a systematic review using meta-regression analysis.
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ABSTRACT:
SUBMITTER: Braghiroli KS
PROVIDER: S-EPMC5453984 | biostudies-literature | 2017 Jun
REPOSITORIES: biostudies-literature
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Perioperative and anesthesia-related cardiac arrests in geriatric patients: a systematic review using meta-regression analysis.
Braghiroli Karen S KS Braz José R C JRC Rocha Bruna B El Dib Regina R Corrente José E JE Braz Mariana G MG Braz Leandro G LG
Scientific reports 20170601 1
The worldwide population is aging, and the number of surgeries performed in geriatric patients is increasing. This systematic review evaluated anesthetic procedures to assess global data on perioperative and anesthesia-related cardiac arrest (CA) rates in geriatric surgical patients. Available data on perioperative and anesthesia-related CA rates over time and by the country's Human Development Index (HDI) were evaluated by meta-regression, and a pooled analysis of proportions was used to compar ...[more]
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Project description: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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Project description:BackgroundThe body of evidence showed that perioperative cardiac arrest and mortality trends varied globally over time particularly in low and middle-income nations. However, the survival of children after cardiac arrest and its independent predictors are still uncertain and a topic of debate. This study was designed to investigate the mortality of children after a perioperative cardiac arrest based on a systematic review of published peer-reviewed literature.MethodsA comprehensive search was conducted in PubMed/Medline; Science direct, CINHAL, and LILACS from December 2000 to August 2021. All observational studies reporting the rate of perioperative CA among children were included. The data were extracted with two independent authors in a customized format. The methodological quality of the included studies was evaluated using the Newcastle-Ottawa appraisal tool.ResultsA total of 397 articles were identified from different databases. Thirty-eight studies with 3.35 million participants were included. The meta-analysis revealed that the global incidence of perioperative cardiac arrest was 2.54(95% CI: 2.23 to 2.84) per 1000 anesthetics. The global incidence of perioperative mortality was 41.18 (95% CI: 35.68 to 46.68) per 1000 anesthetics.ConclusionThe incidence of anesthesia-related pediatric cardiac arrest and mortality is persistently high in the last twenty years in low and middle-income countries. This probes an investment in continuous medical education of the perioperative staff and adhering with the international standard operating protocols for common procedures and critical situations.RegistrationThis systematic review and meta-analysis is registered in the research registry (UIN: researchregistry6932).
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Project description:BACKGROUND:Previous meta-analyses assessing anesthetic techniques in adult patients undergoing hip fractures surgery are available. However, whether the anesthetic technique is associated with risk of mortality and complications in geriatric patients with hip fractures remains unclear. This study was conducted to assess postoperative outcomes of anesthesia technique in geriatric patients undergoing hip fracture surgery. METHODS:Cochrane Library, PubMed, EMBASE, MEDLINE, CNKI, and CBM were searched from inception up to May 25, 2018. Observational studies and randomized controlled trials (RCTs) that assessed the perioperative outcomes of technique of anesthesia (general or regional [epidural/spinal/neuraxial]) in geriatric patients (?60 years old) undergoing hip fracture surgery were included. Two investigators independently screened studies for inclusion and performed data extraction. Heterogeneity was assessed by the I and Chi-square tests. The odds ratio (OR) of the dichotomous data, mean difference (MD) of continuous data, and 95% confidence intervals (CI) were calculated to assess the pooled data. RESULTS:Eleven retrospective and 2 RCTs were included. There was no difference in 30-day mortality (OR?=?0.96; 95% CI 0.86-1.08; P?=?.51) between the general and regional anesthesia groups. In-hospital mortality (OR?=?1.26; 95% CI 1.17-1.36; P?<?.001), acute respiratory failure (OR?=?2.66; 95% CI 2.34-3.02; P?<?.001), length of hospital stay (MD?=?0.33; 95% CI 0.24-0.42; P?<?.001), and readmission (OR?=?1.09; 95% CI 1.01-1.18; P?=?.03) were significantly reduced in the regional anesthesia group. Pneumonia (OR?=?0.99; 95% CI 0.91-1.07; P?=?.79), heart failure (OR?=?0.97; 95% CI 0.86-1.09; P?=?.62), acute myocardial infraction (OR?=?1.07; 95% CI 0.99-1.16; P?=?.10), acute renal failure (OR?=?1.32; 95% CI 0.97-1.79; P?=?.07), cerebrovascular accident (OR?=?1.08; 95% CI 0.82-1.42; P?=?.58), postoperative delirium (OR?=?1.51; 95% CI 0.16-13.97; P?=?.72), and deep vein thrombosis/pulmonary embolism (OR?=?1.42; 95% CI 0.84-2.38; P?=?.19) were similar between the two anesthetic techniques. CONCLUSION:General anesthesia is associated with increased risk of in-hospital mortality, acute respiratory failure, longer hospital stays, and higher readmission. There is evidence to suggest that regional anesthesia is associated with improved perioperative outcomes. Large RCTs are needed to explore the most optimal anesthetic techniques for geriatric patients with hip fractures before drawing final conclusions. PROSPERO REGISTRATION NUMBER:CRD42018093582.
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Project description:BackgroundThe effects of perioperative statin therapy on clinical outcome after cardiac or non-cardiac surgery are controversial. We aimed to assess the association between perioperative statin therapy and postoperative outcome.MethodsElectronic databases were searched up to May 1, 2018, for randomized controlled trials of perioperative statin therapy versus placebo or no treatment in adult cardiac or non-cardiac surgery. Postoperative outcomes were: myocardial infarction, stroke, acute kidney injury (AKI), and mortality. We calculated risk ratio (RR) or odds ratio (OR) and 95% confidence interval (CI) using fixed-effects meta-analyses. We performed meta-regression and subgroup analyses to assess the possible influence of statin therapy regimen on clinical outcomes and trial sequential analysis to evaluate the risk of random errors and futility.ResultsWe included data from 35 RCTs involving 8200 patients. Perioperative statin therapy was associated with lower incidence of postoperative myocardial infarction in non-cardiac surgery (OR = 0.44 [95% CI 0.30-0.64], p < 0.0001), but not in cardiac surgery (OR = 0.93 [95% CI 0.70-1.24], p = 0.61) (psubgroup = 0.002). Higher incidence of AKI was present in cardiac surgery patients receiving perioperative statins (RR = 1.15 [95% CI 1.00-1.31], p = 0.05), nonetheless not in non-cardiac surgery (RR = 1.52 [95% CI 0.71-3.26], p = 0.28) (psubgroup = 0.47). No difference in postoperative stroke and mortality was present in either cardiac or non-cardiac surgery. However, low risk of bias trials performed in cardiac surgery showed a higher mortality with statins versus placebo (OR = 3.71 [95% CI 1.03-13.34], p = 0.04). Subgroup and meta-regression analyses failed to find possible relationships between length of statin regimens and clinical outcomes. Trial sequential analysis suggested no firm conclusions on the topic.ConclusionsPerioperative statins appear to be protective against postoperative myocardial infarction in non-cardiac surgery and associated with higher AKI in cardiac surgery. Possible positive or even negative effects on mortality could not be excluded and merits further investigations. Currently, no randomized evidence supports the systematic administration of statins in surgical patients.
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Project description:ObjectivesComprehensive geriatric assessment (CGA) is a complex intervention applied to older people with evidence of benefit in medical populations. The aim of this systematic review was to describe how CGA is applied to surgical populations in randomised controlled trials. This will provide a basis for design of future studies focused on optimising CGA as a complex intervention.SettingA systematic review of randomised controlled trials.ParticipantsA systematic search was performed for studies of CGA in the perioperative period across Ovid MEDLINE, Ovid EMBASE, CINAHL and Cochrane CENTRAL, from inception to March 2021.InterventionsAny randomised controlled trials of perioperative CGA versus 'standard care' were included.Outcome measuresQualitative description of CGA.Results12 121 titles and abstracts were screened, 68 full-text articles were assessed for eligibility and 22 articles included, reporting on 13 trials. 10 trials focused on inpatients with hip fracture, with 7 of these delivering CGA on a geriatric medicine ward, 3 on a surgical ward. The remaining three trials were in elective general surgery all delivering CGA on a surgical ward. CGA components, duration of intervention and personnel delivering the intervention were highly variable across the different studies. Trials favoured postoperative delivery of CGA (11/13). Only four trials reported data on adherence to the CGA intervention.ConclusionsCGA as an intervention is variably described and delivered in randomised controlled trials in the perioperative setting. The reporting of both the intervention and standard care is often poor with little focus on adherence. Future research should focus on clearly defining and standardising the intervention as well as measuring adherence within trials.Prospero registration numberCRD42020221797.
| S-EPMC9594523 | biostudies-literature
Project description:BackgroundThe impact of COVID-19 on pre-hospital and hospital services and hence on the prevalence and outcomes of out-of-hospital cardiac arrests (OHCA) remain unclear. The review aimed to evaluate the influence of the COVID-19 pandemic on the incidence, process, and outcomes of OHCA.MethodsA systematic review of PubMed, EMBASE, and pre-print websites was performed. Studies reporting comparative data on OHCA within the same jurisdiction, before and during the COVID-19 pandemic were included. Study quality was assessed based on the Newcastle-Ottawa Scale.ResultsTen studies reporting data from 35,379 OHCA events were included. There was a 120% increase in OHCA events since the pandemic. Time from OHCA to ambulance arrival was longer during the pandemic (p?=?0.036). While mortality (OR?=?0.67, 95%-CI 0.49-0.91) and supraglottic airway use (OR?=?0.36, 95%-CI 0.27-0.46) was higher during the pandemic, automated external defibrillator use (OR?=?1.78 95%-CI 1.06-2.98), return of spontaneous circulation (OR?=?1.63, 95%CI 1.18-2.26) and intubation (OR?=?1.87, 95%-CI 1.12--3.13) was more common before the pandemic. More patients survived to hospital admission (OR?=?1.75, 95%-CI 1.42-2.17) and discharge (OR?=?1.65, 95%-CI 1.28-2.12) before the pandemic. Bystander CPR (OR?=?1.18, 95%-CI 0.95-1.46), unwitnessed OHCA (OR?=?0.84, 95%-CI 0.66-1.07), paramedic-resuscitation attempts (OR?=?1.19 95%-CI 1.00-1.42) and mechanical CPR device use (OR?=?1.57 95%-CI 0.55-4.55) did not defer significantly.ConclusionsThe incidence and mortality following OHCA was higher during the COVID-19 pandemic. There were significant variations in resuscitation practices during the pandemic. Research to define optimal processes of pre-hospital care during a pandemic is urgently required.Review registrationPROSPERO (CRD42020203371).
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Project description:Perioperative cardiac arrest (POCA) is associated with a high mortality rate. This work aimed to study its prognostic factors for risk mitigation by means of care management and planning. A database of 380,919 surgeries was reviewed, and 150 POCAs were curated. The main outcome was mortality prior to hospital discharge. Patient demographic, medical history, and clinical characteristics (anesthesia and surgery) were the main features. Six machine learning (ML) algorithms, including LR, SVC, RF, GBM, AdaBoost, and VotingClassifier, were explored. The last algorithm was an ensemble of the first five algorithms. k-fold cross-validation and bootstrapping minimized the prediction bias and variance, respectively. Explainers (SHAP and LIME) were used to interpret the predictions. The ensemble provided the most accurate and robust predictions (AUC = 0.90 [95% CI, 0.78-0.98]) across various age groups. The risk factors were identified by order of importance. Surprisingly, the comorbidity of hypertension was found to have a protective effect on survival, which was reported by a recent study for the first time to our knowledge. The validated ensemble classifier in aid of the explainers improved the predictive differentiation, thereby deepening our understanding of POCA prognostication. It offers a holistic model-based approach for personalized anesthesia and surgical treatment.
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