| Mortality associated with anaesthesia: a qualitative analysis to identify risk factors. | |
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MedLine Citation:
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PMID: 11736769 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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From a prospectively defined cohort of patients who underwent either general, regional or combined anaesthesia from 1 January 1995 to 1 January 1997 (n = 869 483), all consecutive patients (n = 811) who died within 24 h or remained unintentionally comatose 24 h after anaesthesia were classified to determine a relationship with anaesthesia. These deaths (n = 119; 15%) were further analysed to identify contributing aspects of the anaesthetic management, other factors and the appropriateness of care. The incidence of 24-h peri-operative death per 10 000 anaesthetics was 8.8 (95% CI 8.2-9.5), of peri-operative coma was 0.5 (0.3-0.6) and of anaesthesia-related death 1.4 (1.1-1.6). Of the 119 anaesthesia-related deaths, 62 (52%) were associated with cardiovascular management, 57 (48%) with other anaesthetic management, 12 (10%) with ventilatory management and 12 (10%) with patient monitoring. Inadequate preparation of the patient contributed to 30 (25%) of the anaesthesia-related deaths. During induction of anaesthesia, choice of anaesthetic technique (n = 18 (15%)) and performance of the anaesthesiologist (n = 8 (7%)) were most commonly associated with death. During maintenance, the most common factors were cardiovascular management (n = 43 (36%)), ventilatory management (n = 12 (10%)) and patient monitoring (n = 12 (10%)). In both the recovery and the postoperative phases, patient monitoring was the most common factor (n = 12 (10%) for both). For cardiovascular, ventilatory and other anaesthetic management, human failure contributed to 89 (75%) deaths and organisational factors to 12 (10%). For inadequate patient monitoring, human factors contributed to 71 (60%) deaths and organisational factors to 48 (40%). Other contributing factors were inadequate communication (30 deaths (25%) for all four aspects of the anaesthetic management) and lack of supervision (particularly for ventilatory management). Inadequate care was delivered in 19 (16%) of the anaesthesia-related deaths with respect to cardiovascular management, in 20 (17%) with respect to ventilatory management, in 18 (15%) with respect to patient monitoring and in 23 (19%) with respect to other anaesthetic management. |
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Authors:
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M S Arbous; D E Grobbee; J W van Kleef; J J de Lange; H H Spoormans; P Touw; F M Werner; A E Meursing |
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Publication Detail:
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Type: Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Anaesthesia Volume: 56 ISSN: 0003-2409 ISO Abbreviation: Anaesthesia Publication Date: 2001 Dec |
Date Detail:
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Created Date: 2001-12-12 Completed Date: 2001-12-28 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0370524 Medline TA: Anaesthesia Country: England |
Other Details:
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Languages: eng Pagination: 1141-53 Citation Subset: AIM; IM |
Affiliation:
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Department of Anaesthesia, Leiden University Medical Center, Leiden, The Netherlands. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Anesthesia
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adverse effects,
mortality* Cardiovascular Diseases / mortality, therapy Cause of Death Female Hospital Bed Capacity Hospital Mortality Humans Male Medical Errors / statistics & numerical data Monitoring, Intraoperative Monitoring, Physiologic Netherlands / epidemiology Perioperative Care Prospective Studies Respiration Disorders / mortality, therapy Risk Factors |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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