Early perioperative mortality in a multidisciplinary hospital.

Objectives: To evaluate the incidence and the causes of early intra- and po stoperative deaths in a multidisciplinary hospital. Study design: Retrospective survey. Patients: AII patients receiving an anaesthetic between 1992 and 1995. Methods: Analysis of all deaths occurring during anaesthesia and in the sub sequent 24 hours. Demographic data (age, gender) and medical data (ASA phys ical class, type of surgery and degree of emergency) were recorded. The con tribution of anaesthesia, surgery or patient disease to fatal outcome was a nalysed. Results: The analysis included 52,654 patients who underwent either general anaesthesia or epidural analgesia. Perioperative mortality (n = 170) was 1 /310 patients (0.32%). The risk factors for mortality (multivariate analysi s) were: age > 64 years (odds-ratio [OR] 4.8), ASA class greater than or eq ual to 3 (OR 16.6), emergency surgery (OR 3.6), duration of surgery > 115 m inutes (OR 3.4) or occurrence of a perioperative complication (OR 37.4). Fi fty percent of deaths (95% confidence interval [CI] = 42-58) were related t o patient's underlying diseases and 29% to surgery (CI 95% = 22-36). The pe rcentage of deaths linked to anaesthesia was 17.6% (CI 95% = 11.9-23.3, 1/1 ,755), consisting of 8.2% (CI 95% = 4.1-9.3, 1/3,761) totally due to anaest hesia and 9.4% (CI 95% = 5-13.8, 1/3,291) only partially. The main aetiolog ies of the deaths linked to anaesthesia were a mismanagement of severe haem orrhages (30%), respiratory complications (23%) or cardiac complications (2 3%). The mismanagement of an intraoperative critical situation (46%) and a mistake in the postoperative care (33%) were the main causes. Discussion: In this survey, mortality due to anaesthesia was higher than th e rates reported in other studies. Human error remained the main cause. (C) 1998 Elsevier, Paris.