Perioperative morbidity and mortality in the first year of life: a systematic review (1997-2012)

Catré, Dora; Lopes, Maria Francelina; Viana, Joaquim Silva; Cabrita, António Silvério

doi:10.1016/j.bjane.2013.03.025

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Revista Brasileira de Anestesiologia

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Review Articles • Rev. Bras. Anestesiol. 65 (5) • Sep-Oct 2015 • https://doi.org/10.1016/j.bjane.2013.03.025 copy

Perioperative morbidity and mortality in the first year of life: a systematic review (1997-2012)

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

BACKGROUND AND OBJECTIVES:

Although many recognize that the first year of life and specifically the neonatal period are associated with increased risk of anesthetic morbidity and mortality, there are no studies directed to these pediatric subpopulations. This systematic review of the scientific literature including the last 15 years aimed to analyze the epidemiology of morbidity and mortality associated with general anesthesia and surgery in the first year of life and particularly in the neonatal (first month) period.

CONTENT:

The review was conducted by searching publications in Medline/PubMed databases, and the following outcomes were evaluated: early mortality in the first year of life (<1 year) and in subgroups of different vulnerability in this age group (0-30 days and 1-12 months) and the prevalence of cardiac arrest and perioperative critical/adverse events of various types in the same subgroups.

CONCLUSIONS:

The current literature indicates great variability in mortality and morbidity in the age group under consideration and in its subgroups. However, despite the obvious methodological heterogeneity and absence of specific studies, epidemiological profiles of morbidity and mortality related to anesthesia in children in the first year of life show higher frequency of morbidity and mortality in this age group, with the highest peaks of incidence in the neonates' anesthesia.

Keywords:
Early mortality; Morbidity: cardiac arrest; Perioperative critical events/adverse events; 1-Year old/1-month old children

Author/s (year); type of publication; period of investigation and location	Deaths included in data collection	Number of procedures, maximum age	Overall mortality in the study/10,000 anesthesias	Subgroups under 1 year of age
				Age	Number of anesthesias	Incidence/10,000 anesthesias
Morita et al. (2001)⁷; R-M; 1999; Japan	First 7 days	732,788 anesthesias at all ages	ND	0–30 d	3509	74.10
Morita et al. (2001)⁷; R-M; 1999; Japan	First 7 days	732,788 anesthesias at all ages	ND	1–12 M	13580	6.63

Morita et al. (2002)⁸; R-M; 2000; Japan	First 7 days	910,757 anesthesias at all ages	ND	0–30 d	ND	26.94
Morita et al. (2002)⁸; R-M; 2000; Japan	First 7 days	910,757 anesthesias at all ages	ND	1–12 M	ND	5.91

Chan e Auler (2002)⁹; R-1C; 1998–1999; Brazil	First 24 hours	82,641 anesthesias at all ages	51	0–30 d	ND	288
Chan e Auler (2002)⁹; R-1C; 1998–1999; Brazil	First 24 hours	82,641 anesthesias at all ages	51	1–12 M	ND	129

Flick et al. (2007)¹⁰; R-1C; 1988–2005; USA	OR and PACU	92,881 anesthesias in children under 18	6.8	0–30 d	1451	144.7
				1–12 M	7807	19.2
				Geral <1 Y	9258	38.9

Bunchungmongkol et al. (2007)¹¹; P-M; 2003–2004; Thailand	First 24 h	25,098 anesthesias in children up to 15 years	15.9	0–12 M	5406	35.1
Ahmed et al. (2009)¹²; R-1C; 1992–2006; Pakistan	OR and PACU	20,216 anesthesias in children under 18	3.46	0–12 M	4376	11.4
Bharti et al. (2009)¹³; R-1C; 2003–2008; India	First 2 days	12,158 anesthesias in children under 18	10.7	0–12 M	4863	18.5

Van der Griend et al. (2011)¹⁴; R-1C; 2003–2008; Australia	First 24 hours	10.1855 anesthesias in children under 18	24 h: 13.4	24 h
				0–30 d	2831	180.1
				1–12 M	12,424	32.2
				Geral <1 Y	15,255	59.7
			30 d: 34.5	30 d: 0–30 d	2831	367.4
				1–12 M	12,424	82.1
				Geral <1 Y	15,255	135.0

Author/s (year); type of publication	Age group	Number of deaths	Age/reported context
Reports concerning deaths related to anesthesia
Kawashima et al. (2002)¹⁵; R-M	0–12 M	0	No deaths related to anesthesia
Bunchungmonkol et al. (2009)²; P-M	0–30 d	1	1 d/bradycardia after inadequate oxygenation due to pneumothorax on postoperative thoracotomy due to tracheoesophageal fistula
Bunchungmonkol et al. (2009)²; P-M	1–12 M	1	6 M/bradycardia in the context of apparent hypovolemia in emerging craniotomy
Ahmed et al. (2009)¹²; R-1C	0–30 d	0	No deaths related to anesthesia
Ahmed et al. (2009)¹²; R-1C	1–12 M	1	8 M/inadequate ventilation after extubation
Van der Griend et al. (2011)¹⁴; R-1C	0–30 d	1	13 d/congenital heart disease
	1–12 M	2	4 M/ex-premature with trisomy 21 and congenital heart disease
	1–12 M	2	4 M/degenerative neurological disease

Reports concerning overall intraoperative and early postoperative deaths
Kawashima et al. (2002)¹⁵; R-M	0–12 M	26	ND/21 deaths related to preoperative complications (17 from cardiovascular events, including 11 congenital heart disease)
Kawashima et al. (2002)¹⁵; R-M	0–12 M	26	ND/5 deaths related to surgery
Flick et al. (2007)^10a; R-1C	0–30 d	4 (in 17 years)	2.11 and 25 d/massive bleeding
	0–30 d	4 (in 17 years)	1 d/due to pericardial tamponade for central catheterization
	1–12 M	0	No death in non-cardiac surgery

Author/s (year); type of publication; period of investigation and location	Cardiac arrest	Number of procedures, maximum age	Overall incidence in the study/10,000 anesthesias	Subgroups under 1 year of age
				Age	Number of anesthesias	Incidence/10,000 anesthesias
Morita et al. (2001)⁷; R-M; 1999; Japan	ND	732,788 anesthesias at all ages	ND	0–30 d	3509	54.1
Morita et al. (2001)⁷; R-M; 1999; Japan	ND	732,788 anesthesias at all ages	ND	1–12 M	13,580	8.8
Morita et al. (2002)⁸; R-M; 2000; Japan	ND	910,757 anesthesias at all ages	ND	0–30 d	ND	28.3
Morita et al. (2002)⁸; R-M; 2000; Japan	ND	910,757 anesthesias at all ages	ND	1–12 M	ND	8.54
Murat et al. (2004)¹⁶; P-1C; 2000–2002; France	OR and PACU	24,165 anesthesias in children up to 15 years	3.3	<1 Y	3681	10.9
Braz et al. (2006)¹⁷; P-1C; 1996–2005; Brazil	OR and PACU	53,718 anesthesias at all ages	34.6	0–30 d	846	177.3
				1–12 M	2368	55.1
				Geral <1 Y	3214	87.1
Flick et al. (2007)¹⁰; R-1C; 1988–2005; USA	OR and PACU	92,881 anesthesias in children up to 18 years	8.6	0–30 d	1451	158.5
				1–12 M	7807	23.1
				Geral <1 Y	9258	44.3
Bunchungmongkol et al. (2007)¹¹; P-M; 2003–2004; Thailand	First 24 hours	25,098 anesthesias in children up to 15 years	19.9	<1 Y	5406	48.1
Ahmed et al. (2009)¹²; R-1C; 1992–2006; Pakistan	OR and PACU	20,216 anesthesias in children up to 18 years^a	4.95	<1 Y	4376	18.3
Bharti et al. (2009)¹³; R-1C; 2003–2008; India	OR and PACU	12,158 anesthesias in children up to 18 years	22.2	<1 Y	4863	35

Author/s (year); type of publication; period of investigation and location	Occurrence period	Number of procedures, maximum age	Overall incidence in the study	Subgroups under 1 year of age
				Age	Number of anesthesias	Incidência
Tay et al. (2001) ¹⁹; P-1C; 1997–1999; Singapore	ND	10,000 pediatric cases	2.78%	<1 Y	1022	8.6%
Morita et al. (2001)⁷; R-M; 1999; Japan	ND	732,788 anesthesias at all ages	ND	0–30 d	ND	1.68%
Morita et al. (2001)⁷; R-M; 1999; Japan	ND	732,788 anesthesias at all ages	ND	1–12 M	ND	0.48%
Morita et al. (2002)⁸; R-M; 2000; Japan	ND	910,757 anesthesias at all ages	ND	0–30 d	ND	0.7%
Morita et al. (2002)⁸; R-M; 2000; Japan	ND	910,757 anesthesias at all ages	ND	1–12 M	ND	0.42%
Murat et al. (2004)¹⁶; P-1C; 2000–2002; France	OR and PACU	24,165 anesthesias in children up to 15 years	3.1% at OR 4.8% at PACU	<1 Y	3681	3.6% at OR
Murat et al. (2004)¹⁶; P-1C; 2000–2002; France	OR and PACU	24,165 anesthesias in children up to 15 years	3.1% at OR 4.8% at PACU	<1 Y	3681	1.47% at PACU
Edomwonyi et al. (2006)²⁰; P-1C; 12 months, year unspecified; Nigeria	OR and PACU	270 anesthesias in children under 16 years	24%	0–30 d	15	26.7%
	OR and PACU	270 anesthesias in children under 16 years	24%	1–12 M	69	6%–8.7%
Bunchungmongkol et al. (2007)¹¹; P-M; 2003–2004; Thailand	First 24 h	25,098 anesthesias in children up to 15 years	1.9%	<1 Y	5406	4.6%
Samaké et al. (2010)²¹; P-1C; Março-setembro 2004; Mali	ND	107 anesthesias in children up to 12 years	39%	<1 Y	107	30.8%

P-1C, prospective 1 center; R-M, retrospective multicenter; P-M, prospective multicenter; ND, unavailable information; OR, operating room; PACU, post-anesthesia care unit; Definition of critical event or adverse event, Ref.1919. Tay CL, Tan GM, Ng SB. Critical incidents in paediatric anaes- thesia: an audit of 10 000 anaesthetics in Singapore.. Paediatr Anaesth 2001;11:711-8. - respiratory, cardiovascular, and related to the equipment, drugs, regional anesthesia, and others, including seizures, deaths, and dental injuries; Ref.77. Morita K, Kawashima Y, Irita K, et al. Perioperative mortal- ity and morbidity in 1999 with a special reference to age in 466 certified training hospitals of Japanese Society of Anesthesiologists - Report of Committee on Operating Room Safety of Japanese Society of Anesthesiologists. Masui. 2001;50: 909-21. ^and 88. Morita K, Kawashima Y, Irita K, et al. Perioperative mortality and morbidity in the year 2000 in 520 certified training hos- pitals of Japanese Society of Anesthesiologists: with a special reference to age - Report of Japanese Society of Anesthesiol- ogists Committee on Operating Room Safety.. Masui 2002;51: 1285-96. - cardiac arrest, severe hypotension, severe hypoxemia; Ref.1616. Murat I, Constant I, Maud'huy H. Perioperative anaesthetic mor- bidity in children: a database of 24,165 anaesthetics over a 30-month period.. Paediatr Anaesth; 2004 14:158-66. - cardiovascular, neurological, related to regional anesthesia and others, including anaphylaxis, malignant hyperthermia, dose error, prolonged neuromuscular blockade, hypo or hyperthermia, vomiting, postoperative hemorrhage, and equipment failure; Ref.2020. Edomwonyi NP, Ekwere IT, Egbekun R, et al. Anesthesia- related complications in children. Middle East J Anesthesiol. 2006;18:915-27. - cardiovascular, respiratory, neurological and gastrointestinal (postoperative nausea and vomiting); Ref.1111. Bunchungmongkol N, Somboonviboon W, Suraseranivongse S, et al. Pediatric anesthesia adverse events: the Thai Anesthesia Incidents Study (Thai Study) database of 25,098 cases.. J Med Assoc Thai 2007;90:2072-9. - pulmonary aspiration, symptomatic esophageal intubation, desaturation for more than 3 minutes, reintubation, difficult intubation (more than 3 attempts or more than 10 minutes), intubation failure, coma/seizure, nerve damage, cardiac arrest, death, anaphylaxis, medication error, equipment failure; Ref.2121. Samaké B, Keita M, Magalie IM, et al. Adverse events of anes- thesia in pediatric surgery scheduled at Gabriel Toure hospital. Mali Med. 2010;25:1-4. - respiratory, cardiovascular, neurological (delay in waking), and gastrointestinal (postoperative vomiting)

Age	Outcomes	Rate per 10,000 anesthesias	Number of studies for calculation (total number of anesthesias)	Variation per 10,000 anesthesias
Mortality
<1 Y	OR/PACU	30	2 (13,634)	11.4–38.9
	First 24 h	53	2 (20,661)	35.1–59.7
	First 2 days	18.5	1 (4863)	18.5
	First 30 days	135	1 (15,255)	135

0–30 d	OR/PACU	144.7	1 (1451)	144.7
	First 7 days	ND	2 (ND)	26.94–74.10
	First 30 days	367.4	1 (2831)	367.4

1–12 M	OR/PACU	19.2	1 (7807)	19.2
	First 7 days	ND	2 (ND)	5.91–6.63
	First 30 days	82.1	1 (12,424)	82.1

Cardiac arrest
<1 Y	OR/PACU	38.6	5 (25,392)	8.9–87.1
<1 Y	First 24 h	48.1	1 (5406)	48.1

0–30 d	OR/PACU	165.4	2 (2297)	158.5–177.3

1–12 M	OR/PACU	30.5	2 (10,175)	23.1–55.1

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[1] * Corresponding author. E-mail: doracatre@gmail.com (D. Catré).