Mortality associated with anaesthesia in New South Wales, 1984‐1990

Abstract

The Special Committee Investigating Deaths Under Anaesthesia (SCIDUA) reviews all deaths under or within 24 h of anaesthesia in the Australian state of New South Wales, with a population of 5.7 million. The Committee is appointed by the Minister for Health, is legally privileged and provides complete confidentiality of its investigations. Deaths are reported to SCIDU by the State Coroner's Office. The anaesthetist involved in each case then is asked to complete and voluntarily return a questionnaire on the event. There is a 92% response rate.In reviewing 1503 deaths in approximately 3.5 million surgical procedures between 1984 and 1990, the Committee concluded that factors under the control of the anaesthetist caused or significantly contributed to the deaths of 172 patients. No better alternative procedure was available in 11 of the cases and, in these, the procedure was carried out properly. The findings demonstrate a rate of one anaesthesia related death in 20 000 operations, compared with 1:5500 in 1960 and 1:lO 250 in 1970.In children under ten years of age, there were 76 deaths investigated, with approximately 280 000 operations in this age group. sixty-three percent of the children were less than one year. The operations involved were chiefly cardiothoracic, laparotomies for necrotising enterocolitis in premature neonates and trauma surgery. Anaesthetic factors were implicated in only one of the 76 deaths.While there are limitations to the study, in its 34 years SCIDUA has provided a credible estimate of anaesthesia related mortality and been able to highlight features of its incidence and pattern. The major anaesthetic factors relating to the deaths remain inadequate pre-and postoperative care, inappropriate choice of anaesthetic technique or drugs and overdosage with anaesthetic agents.

Mortality associated with anaesthesia: a qualitative analysis to identify risk factors

“…Our results are comparable with data from recent studies applying a study method, classification and postoperative observation period similar to ours, in which estimated 24-h perioperative mortality was 20 per 10 000 anaesthetics and anaesthetic mortality 1.9±7.0 per 10 000 anaesthetics) [5,14,18,64,65]. The estimates for 24-h peri-operative mortality (2.5±5 per 10 000 anaesthetics) and anaesthetic mortality (0.3±0.7 per 10 000 anaesthetics) are somewhat smaller if reporting is voluntary [12,13,15,17]. In our study, voluntary data collection probably caused significant underreporting.…”

“…Our data suggest that inadequate preparation may contribute to one-quarter of the anaesthesia-related deaths, against 40±45% in studies with a comparable study design [12,16,17]. In the current study, inadequate preparation was partly associated with organisational factors and`questionable surgery' or`questionable lack of surgery'.…”

Consent and anaesthetic risk

“…Studies of anaestheticrelated mortality in the 1950s reported an incidence of 2.5-6.4:10 000 deaths [11,21,36]. Since then, data from South Africa have shown a decrease from 4.3:10 000 anaesthetic-related deaths to 0.7:10 000 (1972-87) [21]; from 1:5500 to 1:20 000 in New South Wales (NSW), Australia, from 1960 to 1990 [25], and from 0.3:10 000 to 0.13:10 000 for the whole of Australia from 1985 to 1999 [9,25]. These Australian figures exemplify the difficulties inherent in such statistics, as the NSW rate (with compulsory Coroner reporting for all deaths within 24 h of anaesthesia and surgery) is given as 1: 66 183 in the Australia and New Zealand College of Anaesthetists (ANZCA) report [9], yet the number of procedures estimated by the NSW Committee for the same period is approximately half those calculated by the ANZCA report (J Warden & R Holland pers.…”

“…National studies of mortality that assess the quality of the delivery of care continue to highlight factors that contribute to anaesthetic-related mortality: inadequate pre-operative assessment, preparation and resuscitation; inappropriate anaesthetic technique; inadequate perioperative monitoring; lack of supervision; poor postoperative care [25,35,38].…”

Consent and anaesthetic risk

“…Studies of anaesthetic‐related mortality in the 1950s reported an incidence of 2.5–6.4:10 000 deaths [11, 21, 36]. Since then, data from South Africa have shown a decrease from 4.3:10 000 anaesthetic‐related deaths (1956–71) to 0.7:10 000 (1972–87) [21]; from 1:5500 to 1:20 000 in New South Wales (NSW), Australia, from 1960 to 1990 [25], and from 0.3:10 000 to 0.13:10 000 for the whole of Australia from 1985 to 1999 [9, 25]. These Australian figures exemplify the difficulties inherent in such statistics, as the NSW rate (with compulsory Coroner reporting for all deaths within 24 h of anaesthesia and surgery) is given as 1:66 183 in the Australia and New Zealand College of Anaesthetists (ANZCA) report [9], yet the number of procedures estimated by the NSW Committee for the same period is approximately half those calculated by the ANZCA report (J Warden & R Holland pers.…”