Prediction of outcome of anaesthesia in patients over 40 years: A multifactorial risk index

Tiret, Laurence; Hatton, F; Desmonts, J. M.; Vourc'h, G

doi:10.1002/sim.4780070906

Cited by 86 publications

(62 citation statements)

References 21 publications

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“…There have been several other large studies of outcome after anaesthesia [1][2][3][4]. These were established primarily to estimate important predictors of outcome [2][3][4] and also to compare various anaesthetic techniques [4].…”

Section: Discussionmentioning

confidence: 99%

“…These were established primarily to estimate important predictors of outcome [2][3][4] and also to compare various anaesthetic techniques [4]. Gender has not been found to be a significant predictor of mortality or severe morbidity, though Forrest et al [4] found that males were more likely to have severe postoperative respiratory complications and Warden et al [1] found a preponderance of males in their mortality figures, though they did not adjust for patient and surgical factors.…”

Section: Discussionmentioning

confidence: 99%

“…It is generally accepted that anaesthesia and surgery are associated with a low incidence of mortality or significant morbidity [1][2][3][4]. Because mortality associated with anaesthesia is so low, there has been an increasing tendency for anaesthetic quality assurance programmes to monitor either anaesthetic morbidity or critical incidents [5].…”

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confidence: 99%

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Postoperative ‘minor’ complications

1997

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SummaryWe compared the incidence of postoperative complications in women (vs. men) in 4173 patients. Overall, women were almost twice as likely to report any postoperative complication (RR = 1.92, p < 0.0005). Specifically, they were 2.6 times more likely to report nausea and vomiting (p < 0.0005), 1.5 times more likely to report sore throat (p = 0.0001), 2.3 times more likely to report headache (p < 0.0005) and 2.4 times more likely to report backache (p = 0.0036). Whether these gender differences are due to a reporting bias, or whether in fact women are at greater risk of such complications, remains to be determined.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Postoperative ‘minor’ complications

1997

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“…We used a combination of age, sex, physical status score, length of operation (as a proxy for surgical severity), and emergency status; these variables had been identified earlier as factors of significance to anaesthetic outcomes. [22][23][24] Further refinements in case-mix description will be necessary before more precise comparisons of outcome of anaesthetic care are possible. Nonetheless, it is unlikely that the five-fold magnitude of the differences seen here can be explained by lack of adjustment for yet to be defined variables.…”

Section: Discussionmentioning

confidence: 99%

The Canadian four-centre study of anaesthetic outcomes: II. Can outcomes be used to assess the quality of anaesthesia care?

et al. 1992

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“…Surgical patients are at higher risk of having complications for a variety of reasons, including ASA (American Society of Anesthesiologists) class, 72 [84][85][86] type of anesthesia, 73,78,87,88 and other comorbidities-especially chronic obstructive pulmonary disease, coronary artery disease, and renal failure. 79,80,89 The risk of postoperative complications also depends on the type of surgery.…”

Section: Evidence On Sleep Apnea As a Risk Factor For Perioperative Cmentioning

confidence: 99%

Obstructive Sleep Apnea Syndrome and Perioperative Complications: A Systematic Review of the Literature

Vasu

Grewal

Doghramji

2012

Journal of Clinical Sleep Medicine

217

147

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Obstructive sleep apnea syndrome (OSAS) is a common sleep related breathing disorder. Its prevalence is estimated to be between 2% and 25% in the general population. However, the prevalence of sleep apnea is much higher in patients undergoing elective surgery. Sedation and anesthesia have been shown to increase the upper airway collapsibility and therefore increasing the risk of having postoperative complications in these patients. Furthermore, the majority of patients with sleep apnea are undiagnosed and therefore are at risk during the perioperative period. It is important to identify these patients so that appropriate actions can be taken in a timely fashion. In this review article, we will discuss the epidemiology of sleep apnea in the surgical population. We will also discuss why these patients are at a higher risk of having postoperative complications, with the special emphasis on the role of anesthesia, opioids, sedation, and the phenomenon of REM sleep rebound. We will also review how to identify these patients preoperatively and the steps that can be taken for their perioperative management. OSAS has been shown to be associated with various healthrelated consequences, including increased rate of motor vehicle accidents, hypertension, diabetes mellitus, congestive heart failure, stroke, and all-cause mortality. [1][2][3][4][5][6][7][8][9] Recently, numerous studies have demonstrated that surgical patients with sleep apnea are at increased risk of having perioperative complications, including hypoxemia, pneumonia, diffi cult intubation, myocardial infarction, pulmonary embolism, atelectasis, cardiac arrhythmias, and unanticipated admission to the ICU. The majority of patients with OSA are undiagnosed upon admission and are at risk during the perioperative period, presumably due to their underlying sleep apnea. Therefore, it is very important to identify these patients preoperatively so that one can initiate appropriate perioperative measures. EpidemiologyOSAS is an extremely common sleep related breathing disorder, and its prevalence has been increasing throughout the world because of obesity and increasing age of the general population. Its prevalence is between 2% and 25% in the general population, depending upon how sleep apnea is defi ned. In an epidemiological study, Young et al. noted that the prevalence of sleep apnea, defi ned as apnea-hypopnea index (AHI) ≥ 5/h was 9% for women and 24% for men. 10 However, the prevalence of OSAS (defi ned as AHI ≥ 5/h and daytime sleepiness) was 2% in women and 4% in men. 10 The National Sleep Foundation (NSF) Sleep in America 2005Poll found that 1 in 4 Americans are at high risk of having sleep apnea based on the Berlin Questionnaire. 11 The prevalence of sleep apnea is much higher in surgical patients and depends on the type of surgery. In the bariatric surgery population, the prevalence of sleep apnea has been found to be > 70%. 12,13 It is the standard of care for these patients to get a formal sleep evaluation prior to undergoing the bariatric surgery. Howev...

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Prediction of outcome of anaesthesia in patients over 40 years: A multifactorial risk index

Cited by 86 publications

References 21 publications

Postoperative ‘minor’ complications

Postoperative ‘minor’ complications

The Canadian four-centre study of anaesthetic outcomes: II. Can outcomes be used to assess the quality of anaesthesia care?

Obstructive Sleep Apnea Syndrome and Perioperative Complications: A Systematic Review of the Literature

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