Perioperative and Anesthesia-Related Mortality

In 2006, a previous study at our institution reported high perioperative and anesthesia-related mortality rates of 21.97 and 1.12 per 10,000 anesthetics, respectively. Since then, changes in surgical practices may have decreased these rates. However, the actual perioperative and anesthesia-related mortality rates in Brazil remains unknown. The study aimed to reexamine perioperative and anesthesia-related mortality rates in one Brazilian tertiary teaching hospital. In this observational study, deaths occurring in the operation room and postanesthesia care unit between April 2005 and December 2012 were identified from an anesthesia database. The data included patient characteristics, surgical procedures, American Society of Anesthesiologists (ASA) physical status, and medical specialty teams, as well as the types of surgery and anesthesia. All deaths were reviewed and grouped by into 1 of 4 triggering factors groups: totally anesthesia-related, partially anesthesia-related, surgery-related, or disease/conditionrelated. The mortality rates are expressed per 10,000 anesthetics with 95% confidence intervals (CIs). A total of 55,002 anesthetics and 88 deaths were reviewed, representing an overall mortality rate of 16.0 per 10,000 anesthetics (95% CI: 13.0–19.7). There were no anesthesia-related deaths. The major causes of mortality were patient disease/condition-related (13.8, 95% CI: 10.7– 16.9) followed by surgery-related (2.2, 95% CI: 1.0–3.4). The major risks of perioperative mortality were children younger than 1-year-old, older patients, patients with poor ASA physical status (III–V), emergency, cardiac or vascular surgeries, and multiple surgeries performed . Braz, MD, PhD, ano, MD, riana G. Braz, PhD, and Leandro G. Braz, MD, PhD suggests that primary prevention might be the key to reducing perioperative mortality. These findings demonstrate the need to improve medical perioperative practices for high-risk patients in under-resourced settings. (Medicine 95(2):e2208) Abbreviations: ASA = American Society of Anesthesiologists, CI = confidence interval, OR = operating room, PACU = postanesthesia care unit. INTRODUCTION S afety is a routine concern in anesthesiology. Although cardiac arrest and death rarely occur during the perioperative period, these events represent the worst patient outcomes. A past study of our institution, a general tertiary teaching hospital in Brazil, which is considered a high human development country according to the Human Development Index (HDI) set by the United Nations Development Programme, reported overall and anesthesia-related mortality rates of 21.97 and 1.12 per 10,000 anesthetics, respectively. Furthermore, our previous perioperative and anesthesia-related mortality rates were higher than those reported in studies from very high human development countries (ranging from 3.44 to 18.9 per 10,000 anesthetics and 0.10 to 0.95 per 10,000 anesthetics, respectively) that were published during the same period; these discrepancies were partially attributable to methodology disparities, but decreased access to healthcare is also a factor in our country. In the last decade, Brazil has experienced significant improvements in economy and human indicators, thereby decreasing the inequality in relation to very high human development countries. In addition, in the last 10 years, our institution has developed initiatives to improve the care of surgical patients, including installing anesthesia workstations with ventilators in operating rooms (ORs); monitoring oxygen, carbon dioxide, nitrous oxide, and inhaled anesthetic concentrations; monitoring ventilation, to enable adequate ventilation and anesthesia control; acquiring devices for adequate core temperature control; and increasing the number of staff anesthesiologists and adult intensive care beds. However, the actual perioperative and anesthesiarelated mortality rate in Brazil remains unknown. We hypothesized that identifying and controlling risk factors and improving healthcare conditions following broadly defined institutional initiatives would improve anesthesia care and, consequently, improve surgical patients outcomes. To address the lack of available information concerning perioperative and anesthesia-related mortality, the aim of this study was to reexamine the rates, causes and triggering factors ring anesthesia and in the postanesthesia an 8-year period in a surgical population rtiary teaching hospital. www.md-journal.com | 1