Objective To reveal the incidence,mortality,and risk factors of
bleeding-related perioperative
cardiac arrest(
POCA). Methods We carried out a single-center retrospective case-control study which enrolled all the
POCA cases reported from January 2010 to September 2020 in the patient safety incident reporting system of Peking Union Medical College Hospital.For the screening of risk factors,the patients were respectively assigned into the
POCA group and the control group at a ratio of 1∶3 according to the same sex,age,American Society of Anesthesiologists(ASA)physical status,and type of surgery in the same month.Potential risk factors for
POCA were first selected by univariate analysis.The significant risk factors were then checked based on the clinical experience and further included in the multivariate Logistic regression model. Results Totally 16
bleeding-related
POCA cases were collected from the patient safety incident reporting system among the study period,with an overall incidence of 0.36/10 000.The blood loss volume of
POCA group and control group was(7 037.50±5 477.70)ml and(375.63±675.14)ml,respectively(P<0.001),and 14(87.5%)patients suffering from
bleeding-related
POCA died within three days after
anesthesia.According to the univariate analysis,patients' body mass index[(21.79±3.57)kg/m2 vs.(24.26±3.91)kg/m2,P=0.043],
hemoglobin level[(113.44±31.08)g/L vs.(131.75±19.70)g/L,P=0.039],and
alanine aminotransferase level[(17.31±7.73)U/L vs.(26.91±24.73)U/L,P=0.022]were significantly lower in the
POCA group than in the control group.Further Logistic regression analysis showed that smaller body mass index and lower preoperative
hemoglobin level were independently associated with the occurrence of
bleeding-related
POCA. Conclusions
Bleeding-related
POCA rarely occurred but had high mortality.Adequate precautions should be taken for the patients who are to receive surgeries with high risk of intraoperative massive
bleeding.Elevating preoperative
hemoglobin level might decrease the incidence of
bleeding-related
POCA.