Perioperative mortality is mortality in relation to surgery, often defined as death within two weeks of a surgical procedure. An important consideration in the decision to perform any surgical procedure is to weigh the benefits against the risks. Anesthesiologists and surgeons employ various methods in assessing whether a patient is in optimal condition from a medical standpoint prior to undertaking surgery, and various statistical tools are available.
 Intraoperative causes
 Postoperative causes
 Infectious complications
Local infection of the operative field is prevented by using sterile technique, and prophylactic antibiotics are often given in abdominal surgery or patients known to have a heart defect or mechanical heart valves that are at risk of developing endocarditis.
 Thromboembolic complications
Examples are deep vein thrombosis and pulmonary embolism, the risk of which can be mitigated by certain interventions, such as the administration of anticoagulants (e.g., warfarin or low molecular weight heparins), antiplatelet drugs (e.g., aspirin), compression stockings, and cyclical pneumatic calf compression in high risk patients.
 Pulmonary complications
Many factors can influence the risk of postoperative pulmonary complications (PPC). (A major PPC can be defined as a postoperative pneumonia, respiratory failure, or the need for reintubation after extubation at the end of an anesthetic. Minor post-operative pulmonary complications include events such as atelectasis, bronchospasm, laryngospasm, and unanticipated need for supplemental oxygen therapy after the initial postoperative period.)  Of all patient-related risk factors, good evidence supports patients with advanced age, ASA class II or greater, functional dependence, chronic obstructive pulmonary disease, and congestive heart failure, as those with increased risk for PPC. Of operative risk factors, surgical site is the most important predictor of risk for PPCs (aortic, thoracic, and upper abdominal surgeries being the highest-risk procedures, even in healthy patients. The value of preoperative testing, such as spirometry, to estimate pulmonary risk is of controversial value and is debated in medical literature. Among laboratory tests, a serum albumin level less than 35 g/L is the most powerful predictor and predicts PPC risk to a similar degree as the most important patient-related risk factors.
 Neurologic complications
 Hepatorenal complications
In many countries, statistics are kept by mandatory reporting of perioperative mortality. These may then be used in league tables that compare the quality of hospitals. Critics of this system point out that perioperative mortality may not reflect poor performance but could be caused by other factors, e.g. a high proportion of acute/unplanned surgery. Most hospitals have regular meetings to discuss surgical complications and perioperative mortality. Specific cases may be investigated more closely if a preventable cause has been identified.
Most perioperative mortality is attributable to complications from the operation (such as bleeding, sepsis, and failure of vital organs) or pre-existing medical conditions. Mortality directly related to anesthetic management is less common, and may include such causes as pulmonary aspiration of gastric contents, asphyxiation and anaphylaxis. These in turn may result from malfunction of anesthesia-related equipment or more commonly, human error. A 1978 study found that 82% of preventable anesthesia mishaps were the result of human error.
In a 1954 review of 599,548 surgical procedures at 10 hospitals in the United States between 1948 – 1952, 384 deaths were attributed to anesthesia, for an overall mortality rate of 0.64%. In 1984, after a television program highlighting anesthesia mishaps aired in the United States, American anesthesiologist Ellison C. Pierce appointed a committee called the Anesthesia Patient Safety and Risk Management Committee of the American Society of Anesthesiologists. This committee was tasked with determining and reducing the causes of peri-anesthetic morbidity and mortality. An outgrowth of this committee, the Anesthesia Patient Safety Foundation was created in 1985 as an independent, nonprofit corporation with the vision that "that no patient shall be harmed by anesthesia".
The current mortality attributable to the management of general anesthesia is controversial. Most current estimates of perioperative mortality range from 1 death in 53 anesthetics to 1 in 5,417 anesthetics. The incidence of perioperative mortality that is directly attributable to anesthesia ranges from 1 in 6,795 to 1 in 200,200 anesthetics. There are some studies however that report a much lower mortality rate. For example, a 1997 Canadian retrospective review of 2,830,000 oral surgical procedures in Ontario between 1973 – 1995 reported only four deaths in cases in which either an oral and maxillofacial surgeon or a dentist with specialized training in anesthesia administered the general anesthetic or deep sedation. The authors calculated an overall mortality rate of 1.4 per 1,000,000. It is suggested that these wide ranges may be caused by differences in operational definitions and reporting sources.
The largest and most recent study of postoperative mortality was published in 2010. In this review of 3.7 million surgical procedures at 102 hospitals in the Netherlands during 1991 – 2005, postoperative mortality from all causes was observed in 67,879 patients, for an overall rate of 1.85%.
Anaesthesiologists are committed to continuously reducing perioperative mortality and morbidity. In 2010, the principal European anaesthesiology organisations launched The Helsinki Declaration for Patient Safety in Anaesthesiology, a practically-based manifesto for improving anaesthesia care in Europe.
 See also
- Cook, M.W.; Lisco, S.J. (2009). "Prevention of postoperative pulmonary complications.". International Anesthesiology Clinics 47 (4): 65–88.
- Smetana, G.W.; Lawrence, V. A., Cornell, J. E., & American College of Physicians (2006). "Preoperative pulmonary risk stratification for noncardiothoracic surgery: Systematic review for the american college of physicians.". Annals of Internal Medicine 144 (8): 581–595.
- Smetana, G.W. (2009). "Postoperative pulmonary complications: An update on risk assessment and reduction.". Cleveland Clinic Journal of Medicine 76 (Suppl 4): S60–5.
- Engelhart T and Webster NR (1999). "Pulmonary aspiration of gastric contents in anaesthesia". Br J Anaesth 83 (3): 453–60. PMID 10655918.
- Parker RB (1956). "Maternal Death from Aspiration Asphyxia". BMJ 2 (4983): 16–9. doi:10.1136/bmj.2.4983.16. PMC 2034767. PMID 13329366.
- Dewachter P, Mouton-Faivre C, Emala CW (2009). "Anaphylaxis and Anesthesia: Controversies and New Insights". Anesthesiology 111 (5): 1141–50. doi:10.1097/ALN.0b013e3181bbd443. PMID 19858877.
- Cooper JB, Newbower RS, Long CD, McPeek B (1978). "Preventable anesthesia mishaps: a study of human factors". Anesthesiology 49 (6): 399–406. doi:10.1097/00000542-197812000-00004. PMID 727541.
- Beecher HK; Todd DP (1954). "A study of the deaths associated with anesthesia and surgery based on a study of 599,548 anesthesias in ten institutions 1948-1952, inclusive". Ann Surg 140 (1): 2–34. PMC 1609600. PMID 13159140.
- Guadagnino C (2000). "Improving anesthesia safety". Narberth, Pennsylvania: Physician's News Digest. Retrieved 09-08-2010.
- Stoelting RK (2010). "Foundation History". Indianapolis, IN: Anesthesia Patient Safety Foundation. Retrieved 09-08-2010.
- Cottrell JE (2003). "Uncle Sam, Anesthesia-Related Mortality and New Directions: Uncle Sam Wants You!". ASA Newsletter 67 (1).
- Lagasse RS (2002). "Anesthesia safety: model or myth? A review of the published literature and analysis of current original data". Anesthesiology 97 (6): 1609–17. doi:10.1097/00000542-200212000-00038. PMID 12459692.
- Arbous MS, Meursing AE, van Kleef JW, de Lange JJ, Spoormans HH, Touw P, Werner FM, Grobbee DM (2005). "Impact of anesthesia management characteristics on severe morbidity and mortality". Anesthesiology 102 (2): 257–68. doi:10.1097/00000542-200502000-00005. PMID 15681938.[dead link]
- Nkansah PJ, Haas DA, Saso MA (1997). "Mortality incidence in outpatient anesthesia for dentistry in Ontario". Oral Surg Oral Med Oral Pathol Oral Radiol Endod 83 (6): 646–51. doi:10.1016/S1079-2104(97)90312-7. PMID 9195616.
- Noordzij PG, Poldermans D, Schouten O, Bax JJ, Schreiner FA, Boersma E (2010). "Postoperative mortality in The Netherlands: a population-based analysis of surgery-specific risk in adults". Anesthesiology 112 (5): 1105–15. doi:10.1097/ALN.0b013e3181d5f95c. PMID 20418691.
 Further reading
- Deans, GT; Odling-Smee W, McKelvey ST, Parks GT, Roy DA (1987). "Auditing perioperative mortality". Ann R Coll Surg Engl 69 (4): 185–7. PMC 2498471. PMID 3631878.
- Fong, Y; Gonen M, Rubin D, Radzyner M, Brennan MF (2005). "Long-term survival is superior after resection for cancer in high-volume centers". Ann Surg 242 (4): 540–4. PMC 1402350. PMID 16192814.
- Johnson, ML (2002). Effect of Definition of Mortality on Hospital Profiles. JSTOR 3767954.
- Mayo, SC; Mayo SC, Shore AD, Nathan H, Edil BH, Hirose K, Anders RA, Wolfgang CL, Schulick RD, Choti MA, Pawlik TM (2011). "Refining the definition of perioperative mortality following hepatectomy using death within 90 days as the standard criterion". HPB (Oxford) 13 (7): 473–82. doi:10.1111/j.1477-2574.2011.00326.x. PMC 3133714. PMID 21689231.
- Nixon, SJ (1992). NCEPOD: Revisiting perioperative mortality.
- Ponz de Leon, M; Pezzi A, Benatti P, Manenti A, Rossi G, di Gregorio C, Roncucci L (2009). "Survival, surgical management and perioperative mortality of colorectal cancer in the 21-year experience of a specialised registry". International Journal of Colorectal Disease 24 (7): 777–88. doi:10.1007/s00384-009-0687-1. PMID 19280201.
- Shaw, CD (1990). "PERIOPERATIVE AND PERINATAL DEATH AS MEASURES FOR QUALITY ASSURANCE". International Journal for Quality in Health Care 2 (3–4): 235–41. doi:10.1093/intqhc/2.3-4.235.
- Simunovic, N; Devereaux P, Bhandari M (2011). "Surgery for hip fractures: Does surgical delay affect outcomes?". Indian J Orthop 45 (1): 27–32. doi:10.4103/0019-5413.73660. PMC 3004074. PMID 21221220.
- Start RD, Cross SS, Start RD, Cross SS; Start RD, Cross SS, Start RD, Cross SS (1999). "Acp. Best practice no 155. Pathological investigation of deaths following surgery, anaesthesia, and medical procedures". J Clin Pathol 52 (9): 640–52. PMC 501538. PMID 10655984.
- Schermerhorn, ML; Giles, KA; Sachs, T; Bensley, RP; O'Malley, AJ; Cotterill, P; Landon, BE (2011). "Defining Perioperative Mortality after Open and Endovascular Aortic Aneurysm Repair in the US Medicare Population". Journal of the American College of Surgeons 212 (3): 349–55. doi:10.1016/j.jamcollsurg.2010.12.003. PMC 3051838. PMID 21296011.
- Perioperative Mortality Review Committee, Department of Health, New Zealand (2009). "Terms of Reference for the Perioperative Mortality Review Committee".
- "National Confidential Enquiry into Patient Outcome and Death".