The occurrence of intra‐operative hypotension varies between hospitals: observational analysis of more than 147,000 anaesthesia

Background: Hypotension, a common intra‐operative incident, bears an important potential for morbidity. It is most often manageable and sometimes preventable, which renders its study important. Therefore, we aimed at examining hospital variations in the occurrence of intra‐operative hypotension and its predictors. As secondary endpoints, we determined to what extent hypotension relates to the risk of post‐operative incidents and death.

[1]  D. Reich,et al.  Predictors of Hypotension After Induction of General Anesthesia , 2005, Anesthesia and analgesia.

[2]  K. Tsuzaki,et al.  Anesthesia‐related mortality and morbidity over a 5‐year period in 2,363,038 patients in Japan , 2003, Acta anaesthesiologica Scandinavica.

[3]  K. Sanborn,et al.  Detection of Intraoperative Incidents by Electronic Scanning of Computerized Anesthesia Records: Comparison with Voluntary Reporting , 1996, Anesthesiology.

[4]  E. Korn,et al.  Regression analysis with clustered data. , 1994, Statistics in medicine.

[5]  S. Fasting.  [Risk in anaesthesia]. , 2010, Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke.

[6]  D. Benhamou,et al.  Utilisation d'une base de recueil des incidents anesthésiques : épidémiologie de l'hypotension artérielle peropératoire , 2004 .

[7]  Eric Jougla,et al.  Survey of Anesthesia-related Mortality in France , 2006, Anesthesiology.

[8]  F. Song,et al.  Evaluating non-randomised intervention studies. , 2003, Health technology assessment.

[9]  K. Svärdsudd,et al.  Peroperative and immediate postoperative adverse events in patients undergoing elective general and orthopaedic surgery: The Gothenburg study of perioperative risk (PROPER). Part II , 1995, Acta anaesthesiologica Scandinavica.

[10]  D. Kitzman,et al.  treatment of Hypotension after Hyperbaric Tetracaine Spinal Anesthesia : a Randomized, Double-blind, Cross-over Comparison of Phenylephrine and Epinephrine , 1997 .

[11]  Tiberiu Ezri,et al.  Ľanesthésie rachidienne et péridurale combinée, et péridurale seule, ont une incidence similaire ďhypotension lors de ľarthroplastie du genou , 2006 .

[12]  J. Cooper.  Is voluntary reporting of critical events effective for quality assurance? , 1996, Anesthesiology.

[13]  R. Zimlichman,,et al.  Similar incidence of hypotension with combined spinal-epidural or epidural alone for knee arthroplasty , 2006, Canadian Journal of Anaesthesia-journal Canadien D Anesthesie.

[14]  G. Hempelmann,et al.  Differing Incidences of Relevant Hypotension with Combined Spinal-Epidural Anesthesia and Spinal Anesthesia , 2003, Anesthesia and analgesia.

[15]  G. Fanelli,et al.  Frequency of hypotension and bradycardia during general anesthesia, epidural anesthesia, or integrated epidural-general anesthesia for total hip replacement. , 2002, Journal of clinical anesthesia.

[16]  Axel Junger,et al.  The Incidence and Risk Factors for Hypotension After Spinal Anesthesia Induction: An Analysis with Automated Data Collection , 2002 .

[17]  D. Milamed,et al.  Contributions of the Surgical Sciences to a Reduction of the Mortality Rate in the United States for the Period 1968 to 1988 , 1994, Annals of surgery.

[18]  S. Fasting,et al.  Serious intraoperative problems — a five-year review of 83,844 anesthetics , 2002, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[19]  B Schwilk,et al.  Building a large-scale perioperative anaesthesia outcome-tracking database: methodology, implementation, and experiences from one provider within the German quality project. , 2000, British journal of anaesthesia.

[20]  D. Schroeder,et al.  Predictors of Survival following Cardiac Arrest in Patients Undergoing Noncardiac Surgery: A Study of 518,294 Patients at a Tertiary Referral Center , 2003, Anesthesiology.

[21]  S Greenland,et al.  Multilevel Modeling in Epidemiology with GLIMMIX , 2000, Epidemiology.

[22]  P Royston,et al.  The use of fractional polynomials to model continuous risk variables in epidemiology. , 1999, International journal of epidemiology.

[23]  P. Tsai,et al.  Pre‐operative measurement of heart rate variability predicts hypotension during general anesthesia , 2006, Acta anaesthesiologica Scandinavica.

[24]  D. Kitzman,et al.  Treatment of Hypotension after Hyperbaric Tetracaine Spinal Anesthesia: A Randomized, Double‐blind, Cross‐over Comparison of Phenylephrine and Epinephrine , 1997, Anesthesiology.

[25]  P. Halfon,et al.  Hypertension and intra‐operative incidents: a multicentre study of 125 000 surgical procedures in Swiss hospitals * , 2009, Anaesthesia.

[26]  W. N. Ngan Kee,et al.  A Quantitative, Systematic Review of Randomized Controlled Trials of Ephedrine Versus Phenylephrine for the Management of Hypotension During Spinal Anesthesia for Cesarean Delivery , 2002, Anesthesia and analgesia.

[27]  Pierre-Yves Boëlle,et al.  An Integrated System for Significant Anaesthetic Events Monitoring , 2002, J. Am. Medical Informatics Assoc..

[28]  Mirjam Moerbeek,et al.  A comparison between traditional methods and multilevel regression for the analysis of multicenter intervention studies. , 2003, Journal of clinical epidemiology.

[29]  J. Grizzle.  Analysis of data from multiclinic trials. , 1987, Controlled clinical trials.

[30]  M. Hägerdal,et al.  Reported anaesthetic complications during an 11‐year period. A retrospective study , 1992, Acta anaesthesiologica Scandinavica.

[31]  A. Agresti,et al.  Strategies for comparing treatments on a binary response with multi-centre data. , 2000, Statistics in medicine.

[32]  R. Lagasse,et al.  Anesthesia Safety: Model or Myth?: A Review of the Published Literature and Analysis of Current Original Data , 2002, Anesthesiology.

[33]  M. Larson.  History of Anesthetic Practice , 2010 .

[34]  A. Diez-Roux.  Multilevel analysis in public health research. , 2000, Annual review of public health.

[35]  S. Fasting,et al.  Data recording of problems during anaesthesia: Presentation of a well‐functioning and simple system , 1996, Acta anaesthesiologica Scandinavica.

[36]  W. Tweed,et al.  The Canadian four-centre study of anaesthetic outcomes: II. Can outcomes be used to assess the quality of anaesthesia care? , 1992, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[37]  Lorri A. Lee,et al.  Trends in Anesthesia-related Death and Brain Damage: A Closed Claims Analysis , 2006, Anesthesiology.

[38]  D. Collet.  Modelling Survival Data in Medical Research , 2004 .

[39]  G. Fanelli,et al.  Incidence of hypotension and bradycardia during integrated epidural/general anaesthesia. An epidemiologic observational study on 1200 consecutive patients. Italian Study Group on Integrated Anaesthesia. , 1998, Minerva anestesiologica.

[40]  J. V. van Kleef,et al.  Mortality associated with anaesthesia: a qualitative analysis to identify risk factors , 2001, Anaesthesia.

[41]  S. Tarrac.  A description of intraoperative and postanesthesia complication rates. , 2006, Journal of perianesthesia nursing : official journal of the American Society of PeriAnesthesia Nurses.

[42]  R. James,et al.  1000 anaesthetic incidents: experience to date , 2003, Anaesthesia.