Perianesthetic death: a 10-year retrospective observational study in a Japanese university hospital

Abstract

Background: Studies reporting on perianesthetic death and anesthesia-related death are limited. The present study aimed to assess the incidence of perianesthetic death and its relation to anesthesia and to describe the patient characteristics and main events leading to death in cases of anesthesia-related death and anesthesia-contributory death. Methods: We conducted a retrospective chart review of patients in whom anesthesia procedures were performed by anesthesiologists at a Japanese tertiary hospital between January 2008 and December 2017. Perianesthetic death was defined as death occurring within 48 h of an anesthetic, and it was divided into the following three categories: anesthesia-related death, anesthesia-contributory death, and nonanesthesia-related death. Patient demographics and perioperative factors were analyzed in cases of anesthesia-related death and anesthesia-contributory death. Results: Among 46,378 patients who underwent anesthetics, 41 experienced perianesthetic death, with an incidence of 8.8/10,000 anesthetics (95% confidence interval [CI], 6.1-11.6). No patient experienced anesthesiarelated death, whereas 10 experienced anesthesia-contributory death, with an incidence of 2.1/10,000 (95% CI, 0.69-3.6), and 31 experienced nonanesthesia-related death, with an incidence of 6.8/10,000 (95% CI, 4.2-9.1). The events leading to anesthesia-contributory death were hypovolemia, myocardial infarction, arrhythmia, and respiratory failure, and they occurred during anesthesia maintenance in 5 patients and after surgery in 5 patients. Conclusions: The incidence of perianesthetic death was 8.8/10,000 anesthetics; however, anesthesia-related death was not detected. Ten patients experienced anesthesia-contributory death, and hypovolemia during or after surgery was most frequently associated with anesthesia-contributory death.

A Retrospective Study on Canine and Feline Mortality during Anaesthesia at a University Clinic in Greece

“…A study with 785,467 patients who underwent general anaesthesia demonstrated a death rate attributed solely to anaesthesia of 0.0005% [25]. Another recent study in Japan including 46,378 patients under general anaesthesia reported that none of 41 peri-anaesthetic deaths were caused exclusively by anaesthesia, though but in ten cases anaesthesia was a contributing factor (0.022%) [26]. These considerably lower mortality rates render obvious the gap between medical and veterinary anaesthesia.…”

“…It should be noted that in the human literature expert committees revise and analyse patients' documents and categorise anaesthesia-related deaths according to the causative factor (anaesthesia, procedure, underlying pathology, equipment failure, etc. ), distinguishing peri-anaesthetic deaths between those in which anaesthesia was the definite cause and those in which anaesthesia was a contributing factor [25,26,29]. This extensive classification is unfortunately not the case in the veterinary literature, and as a result the anaesthesia-related mortality rates where anaesthesia was the main cause of death may not reflect the true values.…”