In Europe, out-of-hospital cardiac arrests have an annual incidence rate of 7–17/10,000 per capita and in-hospital cardiac arrests have an annual incidence rate of 15–28/10,000 hospital admissions [1]. The incidence of in-hospital cardiac arrests in Sweden is 16/10,000 hospital admissions [2]. We conducted a study assessing if the incidence of peri-operative cardiac arrest had decreased in Sweden from 2013 to 2022. We also assessed the association between 30-day mortality, patient characteristics and urgency of surgery. All patients aged ≥ 18 y experiencing peri-operative cardiac arrest in the Swedish Perioperative Register (SPOR) between January 2013 and June 2022 were included. Total number of surgical procedures with complete data for patients aged ≥ 18 y registered in SPOR from 2013 to 2022 was used as the denominator (n = 3,049,782).

The primary outcome was the incidence of peri-operative cardiac arrest in 2022 compared with 2013. Secondary outcomes were 30-day all-cause mortality and association of peri-operative cardiac arrest with patient characteristics and urgency. Descriptive and regression analysis was performed. In total, 749 patients (51.6% male, mean (SD) age 69 (17.4) y) experienced peri-operative cardiac arrest during the study period. Patient characteristics and urgency are presented in Table 1. Year was missing for 13 cases of peri-operative cases leaving 736 for analysis. This equates to an overall annual incidence of peri-operative cardiac arrest of 2.4/10,000 procedures (95%CI 2.2–2.6). There was no significant difference over the period studied: 2.9/10,000 procedures in 2013 vs. 1.8/10,000 procedures in 2022. The highest incidence of peri-operative cardiac arrest and highest 30-day mortality rate was seen in patients who underwent emergency surgeries (54%). Hip fracture surgery was the most common planned surgical intervention, (n = 120, 16%) during the study period, followed by abdominal surgery (n = 118, 16%). 30-day mortality following cardiac arrest was 48% and mortality rate was 1.2/10,000 procedures (95%CI 0.7–1.5). Odds ratio (OR) for 30-day mortality increased with age (65–80 y, OR 2.32 (95%CI 1.43–3.77), > 80 y, OR 6.11 (95%CI 3.57–10.45)); ASA physical status 3–5 (OR 2.81 (95%CI 1.74–4.54)); and surgical urgency (emergent OR 2.89 (95%CI 1.85–4.51), immediate 9.20 (95%CI 4.80–17.65)) but showed no significant change over time when adjusted for co-factors.

The overall incidence of peri-operative cardiac arrest in Sweden among adult patients (2.4 per 10,000 procedures) is lower compared with previous studies which ranged between 3–7 per 10,000 [3, 4]. A recent UK study found incidence rates of 3.0–3.5 per 10,000 interventions [4]. In that cohort, however, patients from infancy up to age 18 y (n = 12%) were included in the study. The Royal College of Anaesthetists, in its updated National Audit project (NAP7), defined peri-operative cardiac arrest as “the delivery of five or more compressions and/or defibrillation in a patient having a procedure under the care of an anaesthetist” [5]. The SPOR register includes only peri-operative events and cardiac arrest during the recovery room stay. It should also be acknowledged that the available data did not include medical history, information about comorbidities nor any detailed information about the cardiac arrest. It is reassuring to see that peri-operative cardiac arrest incidence is in line with data from other register studies, which show mortality rates around 50–60% [3].

在欧洲，院外心脏骤停的人均年发病率为 7–17/10,000，院内心脏骤停的年发病率为 15–28/10,000 人入院[ 1 ]。瑞典院内心脏骤停的发生率为 16/10,000 住院患者 [ 2 ]。我们进行了一项研究，评估 2013 年至 2022 年瑞典围手术期心脏骤停的发生率是否有所下降。我们还评估了 30 天死亡率、患者特征和手术紧迫性之间的关联。 2013 年 1 月至 2022 年 6 月期间在瑞典围手术期登记册 (SPOR) 中经历围手术期心脏骤停的所有年龄≥ 18 岁的患者均被纳入。以2013年至2022年在SPOR中登记的年龄≥18岁且具有完整数据的患者的手术总数作为分母（n = 3,049,782）。

主要结局是 2022 年与 2013 年相比围手术期心脏骤停的发生率。次要结局是 30 天全因死亡率以及围手术期心脏骤停与患者特征和紧急程度的关联。进行了描述性和回归分析。总共有 749 名患者（51.6% 为男性，平均 (SD) 年龄 69 (17.4) 岁）在研究期间经历了围手术期心脏骤停。患者特征和紧急程度如表 1 所示。其中 13 例围手术期病例缺少年份，剩下 736 例需要分析。这相当于每年围手术期心脏骤停的总体发生率为 2.4/10,000 例手术 (95%CI 2.2–2.6)。研究期间没有显着差异：2013 年为 2.9/10,000 例手术，2022 年为 1.8/10,000 例手术。接受紧急手术的患者围手术期心脏骤停发生率最高，30 天死亡率最高（ 54%）。研究期间，髋部骨折手术是最常见的计划手术干预（n = 120，16%），其次是腹部手术（n = 118，16%）。心脏骤停后 30 天死亡率为 48%，死亡率为 1.2/10,000 例手术 (95% CI 0.7–1.5)。 30天死亡率的优势比（OR）随着年龄的增长而增加（65-80岁，OR 2.32（95%CI 1.43-3.77），> 80岁，OR 6.11（95%CI 3.57-10.45））； ASA 身体状况 3–5（OR 2.81 (95%CI 1.74–4.54)）；和手术紧迫性（紧急 OR 2.89 (95%CI 1.85–4.51)，即刻 9.20 (95%CI 4.80–17.65)），但在调整辅助因素后，随着时间的推移没有显着变化。

瑞典成年患者围手术期心脏骤停的总体发生率（每 10,000 例手术中有 2.4 例）低于之前的研究（每 10,000 例手术中有 3-7 例）[ 3, 4 ]。英国最近的一项研究发现，每 10,000 次干预措施中，发病率为 3.0-3.5 例 [ 4 ]。然而，在该队列中，从婴儿期到 18 岁的患者 (n = 12%) 均被纳入研究。皇家麻醉师学院在其更新的国家审计项目 (NAP7) 中将围手术期心脏骤停定义为“在麻醉师护理下进行手术的患者中进行五次或以上按压和/或除颤” [ 5 ]。 SPOR 登记仅包括围手术期事件和恢复室期间的心脏骤停。还应该承认，现有数据不包括病史、有关合并症的信息或有关心脏骤停的任何详细信息。令人欣慰的是，围手术期心脏骤停的发生率与其他登记研究的数据一致，显示死亡率约为 50-60% [ 3 ]。