Parada cardíaca perioperatória e relacionada à anestesia: revisão sistemática com meta-análise proporcional e análise de metarregressão
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2016-02-15
Autores
Koga, Fernando Akira [UNESP]
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Universidade Estadual Paulista (Unesp)
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Introdução: A incidência de parada cardíaca (PC) pode ser utilizada como um indicador de qualidade para promover melhorias quanto à segurança do paciente no período perioperatório. Até o momento, não há na literatura mundial nenhuma revisão sistemática com meta-análise de PC relacionada à anestesia. Este estudo buscou analisar dados globais de PC perioperatória e relacionada à anestesia de acordo com o Índice de Desenvolvimento Humano (IDH) e com a variável tempo. Além disso, comparou-se as incidências de PC perioperatória e relacionada à anestesia dos países com baixo e elevado IDH em 2 períodos de tempo. Método: Uma revisão sistemática foi realizada por meio de plataformas eletrônicas de busca para identificar estudos em que pacientes submetidos à anestesia tenham apresentado PC perioperatória e/ou relacionada à anestesia. A meta-análise proporcional e análise de metarregressão foram realizadas utilizando um intervalo de confiança (IC) de 95% para avaliar os dados globais de PC perioperatória e relacionada à anestesia de acordo com o IDH e tempo, e para comparar suas incidências de acordo com o IDH (baixo versus elevado IDH) dos países e de acordo com período (pré 1990 versus período de 1990 - 2014), respectivamente. Resultados: Cinquenta e três estudos provenientes de 21 países, abrangendo 11,9 milhões de anestesias foram incluídos. A meta-análise proporcional demonstrada na proporção de n eventos para 10.000 anestesias apresentaram declínio na incidência de PC perioperatória e relacionada à anestesia em países com elevado IDH (de 8,1 [IC 95%: 5,1-11,9] pré 1990 para 6,2 [IC 95%: 5,1-7,4] no período de 1990-2014, p<0,001, e 2,3 [IC 95%: 1,2-3,7] pré 1990 para 0,7 [IC 95%: 0,5-1,0] no período de 1990-2014, p<0,001; respectivamente). Os países com baixo IDH apresentaram aumento significativo na incidência de PC perioperatória (de 16,4 [IC 95%: 1,5-47,1] pré 1990 para 19,9 [IC 95%: 10,9-31,7] no período de 1990-2014, p=0,03) diferentemente da incidência de PC relacionada à anestesia, que não apresentou alteração significativa (9,2 [IC 95%: 2,0-21,7] pré 1990, para 4,5 [IC 95%: 2,4-7,2] no período de 1990-2014, p=0,14). A metarregressão demonstrou que as incidências de PC perioperatória (slope: -2,4071; IC 95%: -4,0482 a -0,7659; p=0,005) e relacionada à anestesia (slope: -3,5729; IC 95%: -6,6306 a -0,5152; p=0,024) decresceram com o aumento do IDH, mas não com o tempo. Conclusão: Existe uma redução clara e consistente na incidência de PC perioperatória e relacionada à anestesia nos países com elevado IDH, mas um aumento na incidência de PC perioperatória sem alteração significativa na incidência de PC relacionada à anestesia nos países com baixo IDH comparando esses dois períodos de tempo. As incidências de PC perioperatória e relacionada à anestesia reduziram com o aumento do IDH dos países, mas não ao longo do tempo.
Background: The anesthesia-related cardiac arrest (CA) rate is a quality indicator to improve patient safety in the perioperative period. A systematic review with meta-analysis of the worldwide literature related to anesthesiarelated CA rate has not yet been performed. This study aimed to analyze global data on perioperative and anesthesia-related CA rates according to country’s Human Development Index (HDI) and by time. Additionally, we compared the perioperative and anesthesia-related CA rates in low- and high-income countries in two time periods. Methods: A systematic review was performed using electronic databases to identify studies in which patients underwent anesthesia with perioperative and/or anesthesia-related CA rates. Proportional meta-analysis and metaregression were performed with 95% confidence intervals (CI) to compare the perioperative and anesthesia-related CA rates by country’s HDI status (low-HDI versus high-HDI) and by time period (pre-1990s versus 1990s-2010s), and to evaluate global data on perioperative and anesthesia-related CA rates according to country’s HDI and by time, respectively. Results: Fifty-three studies from 21 countries assessing 11.9 million anesthetic administrations were included. Meta-analysis showed per 10,000 anesthetics that perioperative and anesthesia-related CA rates declined in high-HDI (8.1 [95% CI: 5.1-11.9] before the 1990s to 6.2 [95% CI: 5.1-7.4] in the 1990s-2010s, P<0.001, and 2.3 [95% CI: 1.2-3.7] before the 1990s to 0.7 [95% CI: 0.5- 1.0] in the 1990s-2010s, P<0.001; respectively). In low-HDI countries, perioperative CA rates increased significantly (16.4 [95% CI: 1.5-47.1] before the 1990s to 19.9 [95% CI: 10.9-31.7] in the 1990s-2010s, P=0.03) while anesthesia-related CA rates did not alter significantly (9.2 [95% CI: 2.0-21.7] before the 1990s to 4.5 [95% CI: 2.4-7.2] in the 1990s-2010s, P=0.14). Metaregression showed that perioperative (slope: -2.4071; 95% CI: -4.0482 to -0.7659; P=0.005) and anesthesia-related (slope: -3.5729; 95% CI: -6.6306 to -0.5152; P=0.024) CA rates decreased with increasing HDI, but not with time. Conclusions: There is a clear and consistent reduction in perioperative and anesthesia-related CA rates in high-HDI countries, but an increase in perioperative CA rates without significant alteration in the anesthesia-related CA rates in low-HDI countries comparing the two time periods. Both perioperative and anesthesia-related CA rates decrease with increasing HDI but not with time by meta-regression.
Background: The anesthesia-related cardiac arrest (CA) rate is a quality indicator to improve patient safety in the perioperative period. A systematic review with meta-analysis of the worldwide literature related to anesthesiarelated CA rate has not yet been performed. This study aimed to analyze global data on perioperative and anesthesia-related CA rates according to country’s Human Development Index (HDI) and by time. Additionally, we compared the perioperative and anesthesia-related CA rates in low- and high-income countries in two time periods. Methods: A systematic review was performed using electronic databases to identify studies in which patients underwent anesthesia with perioperative and/or anesthesia-related CA rates. Proportional meta-analysis and metaregression were performed with 95% confidence intervals (CI) to compare the perioperative and anesthesia-related CA rates by country’s HDI status (low-HDI versus high-HDI) and by time period (pre-1990s versus 1990s-2010s), and to evaluate global data on perioperative and anesthesia-related CA rates according to country’s HDI and by time, respectively. Results: Fifty-three studies from 21 countries assessing 11.9 million anesthetic administrations were included. Meta-analysis showed per 10,000 anesthetics that perioperative and anesthesia-related CA rates declined in high-HDI (8.1 [95% CI: 5.1-11.9] before the 1990s to 6.2 [95% CI: 5.1-7.4] in the 1990s-2010s, P<0.001, and 2.3 [95% CI: 1.2-3.7] before the 1990s to 0.7 [95% CI: 0.5- 1.0] in the 1990s-2010s, P<0.001; respectively). In low-HDI countries, perioperative CA rates increased significantly (16.4 [95% CI: 1.5-47.1] before the 1990s to 19.9 [95% CI: 10.9-31.7] in the 1990s-2010s, P=0.03) while anesthesia-related CA rates did not alter significantly (9.2 [95% CI: 2.0-21.7] before the 1990s to 4.5 [95% CI: 2.4-7.2] in the 1990s-2010s, P=0.14). Metaregression showed that perioperative (slope: -2.4071; 95% CI: -4.0482 to -0.7659; P=0.005) and anesthesia-related (slope: -3.5729; 95% CI: -6.6306 to -0.5152; P=0.024) CA rates decreased with increasing HDI, but not with time. Conclusions: There is a clear and consistent reduction in perioperative and anesthesia-related CA rates in high-HDI countries, but an increase in perioperative CA rates without significant alteration in the anesthesia-related CA rates in low-HDI countries comparing the two time periods. Both perioperative and anesthesia-related CA rates decrease with increasing HDI but not with time by meta-regression.
Descrição
Palavras-chave
Anesthesia, Cardiac arrest, High-income population, Low-income population, Meta-analysis, Systematic review, Anestesia, Parada cardíaca, Países desenvolvidos, Países em desenvolvimento, Meta-análise, Revisão sistemática