Anaesthesia-related mortality within 24 h following 9,391,669 anaesthetics in 10 cities in Hubei Province, China: a serial cross-sectional study

Yu Wang; Jie Wang; Xihong Ye; Rui Xia; Ran Ran; Yaohua Wu; Qinghong Chen; Haopeng Li; Shiqian Huang; Aihua Shu; Longqiu Yang; Bin Qin; WenLi Dong; Zhongyuan Xia; Zongze Zhang; Li Wan; Xiaohong Peng; Juying Liu; Zaiping Wang; Yanlin Wang; Peng Yin; Xiangdong Chen; Shanglong Yao

doi:10.1016/j.lanwpc.2023.100787

Anaesthesia-related mortality within 24 h following 9,391,669 anaesthetics in 10 cities in Hubei Province, China: a serial cross-sectional study

Lancet Reg Health West Pac. 2023 May 15:37:100787. doi: 10.1016/j.lanwpc.2023.100787. eCollection 2023 Aug.

Authors

Yu Wang^{1

2}, Jie Wang^{1

2}, Xihong Ye³, Rui Xia⁴, Ran Ran⁵, Yaohua Wu⁶, Qinghong Chen^{1

2}, Haopeng Li^{1

2}, Shiqian Huang^{1

2}, Aihua Shu⁷, Longqiu Yang⁸, Bin Qin⁹, WenLi Dong¹⁰, Zhongyuan Xia¹¹, Zongze Zhang¹², Li Wan¹³, Xiaohong Peng¹⁴, Juying Liu¹⁵, Zaiping Wang⁹, Yanlin Wang¹², Peng Yin¹⁶, Xiangdong Chen^{1

2}, Shanglong Yao^{1

2}

Affiliations

¹ Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
² Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, China.
³ Department of Anesthesiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China.
⁴ Department of Anesthesiology, The First Affiliated Hospital of Yangtze University, Jingzhou, China.
⁵ Department of Anesthesiology, Renmin Hospital, Hubei University of Medicine, Shiyan, China.
⁶ Department of Anesthesiology, Huanggang Central Hospital, Huanggang, China.
⁷ Department of Anesthesiology, The First People's Hospital of Yichang, Yichang, China.
⁸ Department of Anesthesiology, The Central Hospital of Huangshi, Huangshi, China.
⁹ Department of Anesthesiology, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, China.
¹⁰ Department of Anesthesiology, The Central Hospital of Xianning, Xianning, China.
¹¹ Department of Anesthesiology, People's Hospital of Wuhan University, Wuhan, China.
¹² Department of Anesthesiology, Zhongnan Hospital, Wuhan University, Wuhan, China.
¹³ Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
¹⁴ Department of Anesthesiology, Wuhan Fourth Hospitail, Wuhan, China.
¹⁵ Department of Anesthesiology, Shiyan Taihe Hospital, Hubei University of Medicine, Shiyan, China.
¹⁶ National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.

Abstract

Background: The mortality risk related to anaesthesia in China remains poorly characterized. The objective of this study was to evaluate the anaesthesia-related mortality in terms of its incidence, changes, causes and preventability in Hubei, China, between 2017 and 2021 using a series of annual surveys.

Methods: We prospectively collected information on patient, surgical, anaesthesia, and hospital characteristics for 9,391,669 anaesthesia procedures performed between 2017 and 2021 in 10 cities within Hubei Province, China. Anaesthesia-related death was defined as death that deemed to be entirely or partially attributable to anaesthesia, occurring within 24 h following anaesthesia administration. All fatalities were scrutinized consecutively to determine their root causes and preventability. The incidence and patterns of anaesthesia-related deaths were analysed from 2017 to 2021. A mixed-effects model with a Poisson link function was fitted to evaluate the city-level annual changes in risk-adjusted incidence of anaesthesia-related deaths.

Findings: 600 cases of anaesthetic deaths occurred from 2017 to 2021, yielding an incidence of 6.4 per 100,000 anaesthesia procedures [95% confidence interval (95% CI): 5.9, 6.9], and most were preventable (71.3%). There was a significant decrease from 2017 to 2021, in the incidences of anaesthesia-related death across all patients, those with American Society of Anaesthesiologists physical status (ASAPS) ≥III, and those who had general anaesthesia, with a percentage reduction of 57.6%, 59.1%, and 55.9%, respectively. The risk-adjusted annual changes indicated significant downward trends for the incidence of anaesthetic mortality from 2017 to 2018, 2019, 2020, and 2021. For instance, the risk-adjusted annual changes for the anaesthetic mortality incidence from 2017 to 2021 was -2.5 (95% CI: -1.4, -4.7).

Interpretation: In this large, comprehensive database study conducted in Central China, the anaesthesia-related death incidence was 6.4 per 100,000. Notably, the incidence of anaesthesia-related deaths decreased between 2017 and 2021. However, further in-depth analysis is needed to understand the extent to which these trends represent a change in patient safety.

Funding: Innovation and optimization of perioperative respiratory system management strategy (Hubei Technological Innovation Special Fund, 2019ACA167).

Keywords: Anaesthesia-related mortality; China; Serial cross-sectional study.