What is the Incidence and Common Cause of Anesthetic Death in 2014?

Brian Hall, MD; Richard Dutton, MD, MBA

A

Dear Q&A,

What is the incidence and common cause of anesthetic death in 2014?

Brian Hall, MD Department of Anesthesiology Mayo Clinic Rochester, MN

A Dear Dr. Hall,

Thank you for the inquiry. There are various possible answers to this question, depending on what you mean by “anesthetic death” and when you are attempting to find it. Here are some general answers:

Mortality prior to hospital discharge in patients admitted for surgery (inpatient operations) is about 3-4% in western medicine in several recent large studies. Most deaths are due to underlying illness and frailty.

Mortality in the OR or PACU is about 3/10,000 (.03%), and is again mostly due to underlying disease, such as severe trauma or overwhelming sepsis. Death is 1000x more likely in an ASA 5 than an ASA 1 patient.

Attribution of mortality (i.e. “preventable mortality”) is often difficult. If a patient dies from an MI on POD 1 whose fault was it? The anesthesiologist who was managing vital signs, the surgeon who was inflicting stress and managed the patient overnight, or the nurse who forgot to give the beta blockers? Or was it primarily related to the patient’s underlying disease processes?

Unexpected perioperative mortality, which would be deemed “definitely preventable,” from the anesthesia perspective, occurs a handful of times per million cases. Airway management is a major contributor, but used to be much more common than it is now. My estimate is that it ranks at about the same level as unrecognized hemorrhage and over-sedation now, with failure to recognize anaphylaxis, malignant hyperthermia, local anesthetic systemic toxicity (LAST), and others trailing a little behind.

The good news is that these things happen so rarely that getting a handle on them statistically is impossible. I prefer to regard them all as sentinel events, each worthy of their own detailed review.

Richard Dutton, MD, MBA Executive Director Anesthesia Quality Institute Chief Quality Officer American Society of Anesthesiologists

General References

  1. Pearse RM, et al; Mortality after surgery in Europe: a 7 day cohort study. European Surgical Outcomes Study (EuSOS) group for the Trials groups of the EuropeanSociety of Intensive Care Medicine and the European Society of Anaesthesiology. Lancet. 2012;380:1059-65.
  2. Dimick JB, et al. Reliability adjustment for reporting hospital outcomes with surgery. Ann Surg. 2012;255:703-7.
  3. Velanovich V, et al. Accumulating deficits model of frailty and postoperative mortality and morbidity: its application to a national database. J Surg Res. 2013;183:104-10.
  4. Anderson JE, et al. An efficient risk adjustment model to predict inpatient adverse events after surgery. World J Surg. 2014;38:1954-60.

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