title: Anesthesia-Related and Perioperative Cardiac Arrest in Low- and High-Income Countries: A Systematic Review With Meta-Regression and Proportional Meta-Analysis.
abstract: 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 anesthesia-related CA rate has not yet been performed.This study aimed to analyze global data on anesthesia-related and perioperative CA rates according to country's Human Development Index (HDI) and by time. In addition, we compared the anesthesia-related and perioperative CA rates in low- and high-income countries in 2 time periods.A systematic review was performed using electronic databases to identify studies in which patients underwent anesthesia with anesthesia-related and/or perioperative CA rates. Meta-regression and proportional meta-analysis were performed with 95% confidence intervals (CIs) to evaluate global data on anesthesia-related and perioperative CA rates according to country's HDI and by time, and to compare the anesthesia-related and perioperative CA rates by country's HDI status (low HDI vs high HDI) and by time period (pre-1990s vs 1990s-2010s), respectively.Fifty-three studies from 21 countries assessing 11.9 million anesthetic administrations were included. Meta-regression showed that anesthesia-related (slope: -3.5729; 95% CI: -6.6306 to -0.5152; P = 0.024) and perioperative (slope: -2.4071; 95% CI: -4.0482 to -0.7659; P = 0.005) CA rates decreased with increasing HDI, but not with time. Meta-analysis showed per 10,000 anesthetics that anesthesia-related and perioperative CA rates declined in high HDI (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; and 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, respectively). In low-HDI countries, 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), whereas 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).Both anesthesia-related and perioperative CA rates decrease with increasing HDI but not with time. There is a clear and consistent reduction in anesthesia-related and perioperative 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 2 time periods.
authors.affiliation: From the Anesthesia Cardiac Arrest and Mortality Study Commission (FAK, RED, WW, CTR, MGB, JRCB, LGB), Department of Anesthesiology, Botucatu Medical School, Univ Estadual Paulista (UNESP); and Department of Biostatistics (JEC), Institute of Biosciences, Univ Estadual Paulista (UNESP), Botucatu, Brazil.
authors.forename: Fernando A
authors.initials: FA
authors.lastname: Koga
authors.forename: Regina El
authors.initials: RE
authors.lastname: Dib
authors.forename: William
authors.initials: W
authors.lastname: Wakasugui
authors.forename: Cairo T
authors.initials: CT
authors.lastname: Roça
authors.forename: José E
authors.initials: JE
authors.lastname: Corrente
authors.forename: Mariana G
authors.initials: MG
authors.lastname: Braz
authors.forename: José R C
authors.initials: JRC
authors.lastname: Braz
authors.forename: Leandro G
authors.initials: LG
authors.lastname: Braz
mesh_terms: D000758:Anesthesia / Q000009:adverse effects* / Q000379:methods; D019049:Developed Countries / Q000706:statistics & numerical data; D003906:Developing Countries / Q000706:statistics & numerical data; D006323:Heart Arrest / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D011183:Postoperative Complications / Q000453:epidemiology*; D013514:Surgical Procedures, Operative / Q000009:adverse effects* / Q000379:methods