Perioperative and anesthesia-related cardiac arrests in geriatric patients: a systematic review using meta-regression analysis

Braghiroli, Karen Santos; Bráz, José Reinaldo Cerqueira; Rocha, Bruna Dedavid da; Dib, Regina El; Corrente, José Eduardo; Braz, Mariana Gobbo; Braz, Leandro Gobbo

doi:10.1038/s41598-017-02745-6

Cited by 25 publications

(21 citation statements)

References 38 publications

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“…The number of lymph nodes identified is slightly reduced in delayed ALND patients without clinical significance and the risk of lymphedema is similar between delayed and immediate ALND [29,30]. The major risk from delayed ALND for FNSN patients comes from perioperative and anesthesiarelated distress, especially in elderly patients [31,32]. In present study, two patients had metastasis in SNs and non-sentinel ALNs.…”

Section: Discussionsupporting

confidence: 44%

Non-Inferiority of Survival in Early Breast Cancer Patients with False-Negative Sentinel Nodes After Completing Axillary Lymph Node Dissection

Loh

Lee

Chen

et al. 2020

Preprint

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Background Sentinel lymph node biopsy (SLNB) is standard approach of axillary region for early breast cancer patients with clinically negative node. The present study investigated patients with false-negative sentinel nodes (FNSN) of intraoperative frozen section.Methods A case-control study with 1:3 ratio was conducted. FNSN was diagnosed as negative sentinel nodes (SNs) in frozen sections, but positive for metastasis in formalin-fixed paraffin-embedded (FFPE) blocks. Control was defined no metastasis of SNs in both frozen and FFPE sections.Results Total 20 FNSN cases and 60 matched-controls were enrolled from 333 SLNB patients between April 1, 2005 and November 31, 2009. The demographics and intrinsic subtypes of breast cancer were similar between FNSN and controls. The FNSN patients had a larger tumor size in preoperative mammography and more lymphatic tumor emboli in core biopsy (P-value 0.033 and < 0.001, respectively). Four FNSN patients had metastasis in the non-relevant SNs. Other 16 FNSN patients had results of benign lymphoid hyperplasia of SNs in frozen sections and metastasis in FFPE blocks. Micrometastasis (less than 2 mm) was detected in seven of 16 patients and metastases in non-sentinel nodes was recognized in two of 16 patients. All FNSN patients received second operation with axillary lymph node dissection (ALND). After a median follow-up of 143 months, no FNSN patients developed recurrence of breast cancer. The disease-free survival, disease-specific survival, and overall survival in FNSN were non-inferior than controls.Conclusion Outcomes of FNSN patients after completing ALND was non-inferior to those without metastasis in SNs. ALND improved survival of patients with metastasis non-sentinel ALNs. However, omitting ALND had no effect for those have only micrometastasis in SNs.

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Section: Discussionsupporting

confidence: 44%

Non-Inferiority of Survival in Early Breast Cancer Patients with False-Negative Sentinel Nodes After Completing Axillary Lymph Node Dissection

Loh

Lee

Chen

et al. 2020

Preprint

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“…20 , 36 Upon comparing in the same setting, it was observed that elderly patient was a predictor of death after emergency surgery, as that factor increased the rate by 2.8–4.3 times. 30 As for other studies such as those conducted in the USA, 4 , 11 , 27 , 34 the UK, 37 and Brazil, 38 they showed that elderly patient was a factor contributing to cardiac arrest during anesthesia, especially for patients who were more than 80 years of age. However, those studies had differences with regard to some characteristics of the population selected for entry, such as characteristic data, comorbidity disease, and surgery procedure.…”

Section: Discussionmentioning

confidence: 62%

Incidences and factors associated with perioperative cardiac arrest in trauma patients receiving anesthesia

Siriphuwanun

Punjasawadwong

Saengyo

2018

RMHP

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PurposeThe aim of this study was to determine the incidences and factors associated with perioperative cardiac arrest in trauma patients who received anesthesia for emergency surgery.Patients and methodsThis retrospective cohort study was approved by the medical ethical committee, Faculty of Medicine, Maharaj Nakorn Chiang Mai Hospital, Thailand. Data of 19,683 trauma patients who received anesthesia between January 2007 and December 2016, such as patient characteristics, surgery procedures, anesthesia information, anesthetic drugs, and cardiac arrest outcomes, were analyzed. Data of patients receiving local anesthesia by surgeons or monitoring anesthesia care (MAC) and those with much information missing were excluded. Factors associated with perioperative cardiac arrest were identified using univariate analysis and the multiple regression model. A stepwise algorithm was chosen at a P-value of <0.20 which was selected for multivariate analysis. A P-value of <0.05 was concluded as statistically significant.ResultsThe perioperative cardiac arrest in trauma patients receiving anesthesia for emergency surgery was 170.04 per 10,000 cases. Factors associated with perioperative cardiac arrest in trauma patients were as follows: age >65 years (risk ratio [RR] =1.41, CI =1.02–1.96, P=0.039), American Society of Anesthesiologist (ASA) physical status 3 or higher (ASA physical status 3–4, RR =4.19, CI =2.09–8.38, P<0.001; ASA physical status 5–6, RR =21.58, CI =10.36–44.94, P<0.001), sites of surgery (intracranial, intrathoracic, upper intra-abdominal, and major vascular, each P<0.001), cardiopulmonary comorbidities (RR =1.55, CI =1.10–2.17, P=0.012), hemodynamic instability with shock prior to receiving anesthesia (RR =1.60, CI =1.21–2.11, P<0.001), and having a history of alcoholism (RR =5.27, CI =4.09–6.79, P<0.001).ConclusionThe incidence of perioperative cardiac arrest in trauma patients receiving anesthesia for emergency surgery was very high and correlated with patient’s factors, especially old age and cardiopulmonary comorbidities, a history of drinking alcohol, increased ASA physical status, hemodynamic instability with shock prior to surgery, and sites of surgery such as brain, thorax, abdomen, and the major vascular region. Anesthesiologists and surgeons should be aware of a warning system and a well-equipped track to manage the surgical trauma patients.

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“…Total PO mortality (commonly considered as "death from any cause and cardiac arrest (CA)) has also interest in this field. Globally, there is strong evidence of reduction in anesthetic-related and perioperative mortality over the past 50 years, despite the increasing patients ASA risks (Table 2) and decreasing of CA in the perioperative setting (Braghiroli et al 2017). Developing countries are affected two or three times more by anesthetic-related and perioperative mortality, if compared with developed countries (Avidan and Kheterpal 2012).…”

Section: Introductionmentioning

confidence: 99%

Perioperative and anesthetic deaths: toxicological and medico legal aspects

Argo

Zerbo

Lanzarone

et al. 2019

Egypt J Forensic Sci

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Background: Anesthesia has become safer during decades, though there is still a preventable mortality; the complexity of medical and surgical interventions, increasingly older and sicker patients, has created a host of new hazards in anesthesiology. In this paper, some of these perioperative (PO) fatal adverse events are investigated in terms of health responsibility. Selective literature research in several data bases, concerning perioperative and anesthetic deaths and medical responsibility, was performed. Main text: A generally accepted definition of the anesthesia and perioperatory-related death still remains one of the major concerns in forensic pathology, and the terms "operative deaths" and "anesthetic deaths" are usually applied inaccurately within the medico-legal literature. Such events involve comprehensively PO fatalities and allow for subtle separation of natural and unnatural death, at least from the prospective of forensic pathology. Iatrogenic deaths in this field can be separated into some major categories, as attributable to previous patient's unfavorable conditions or depending from surgical procedure per se (such as PO cardiac and cerebrovascular events). In this review, the authors carried out syntheses of specific research areas regarding epidemiology, complications of general and spinal anesthetic, failure in airway management and patient's circulatory homeostasis, and adverse drugs reactions; analysis considering the challenge of anesthetic-related mortality, epidemiology and classifications, by indicating causal chain of death, in respect of both contributing and associated anesthetic and surgery facts. Conclusions: Perioperative quality control programs and its relevance for medico-legal evaluation are emphasized as, although mortality rates have decreased worldwide over the last decades, however, preventable drug-related deaths still happen. Such fatal events have to be considered within the field of forensic pathology experts, with regard of malpractice claims, to implement a strategy for preventing potentially fatal complications.

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Perioperative and anesthesia-related cardiac arrests in geriatric patients: a systematic review using meta-regression analysis

Cited by 25 publications

References 38 publications

Non-Inferiority of Survival in Early Breast Cancer Patients with False-Negative Sentinel Nodes After Completing Axillary Lymph Node Dissection

Non-Inferiority of Survival in Early Breast Cancer Patients with False-Negative Sentinel Nodes After Completing Axillary Lymph Node Dissection

Incidences and factors associated with perioperative cardiac arrest in trauma patients receiving anesthesia

Perioperative and anesthetic deaths: toxicological and medico legal aspects

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