Survey of Anesthesia-related Mortality in France

Background:This study describes a nationwide survey that estimates the number and characteristics of anesthesia-related deaths for the year 1999. Methods:Death certificates from the French national mortality database were selected from the International Classification of Diseases, Ninth Revision codes using a variable sampling fraction. Medical certifiers were sent a questionnaire (response rate, 97%), and the anesthesiologist in charge was offered a peer review (acceptance rate, 97%). Files were reviewed to determine the mechanism of each perioperative death and its relation to anesthesia. Mortality rates were calculated using the number of anesthetic procedures estimated from a national 1996 survey and compared with a previous (1978–1982) nationwide study. Results:Among the 4,200 certificates analyzed, 256 led to a detailed evaluation. The death rates totally or partially related to anesthesia for 1999 were 0.69 in 100,000 (95% confidence interval, 0.22–1.2 in 100,000) and 4.7 in 100,000 (3.1–6.3 in 100,000), respectively. The death rate increased from 0.4 to 55 in 100,000 for American Society of Anesthesiologists physical status I and IV patients, respectively. Rates increased with increasing age. Although concerns regarding aspiration of gastric contents remain, intraoperative hypotension and anemia associated with postoperative ischemic complications were the associated factors most often encountered. Deviations from standard practice and organizational failure were often found to be associated with death. Conclusion:In comparison with data from a previous nationwide study (1978–1982), the anesthesia-related mortality rate in France seems to be reduced 10-fold in 1999. Much remains to be done to improve compliance of physicians to standard practice and to improve the anesthetic system process.

[1]  M. Warner,et al.  Clinical Significance of Pulmonary Aspiration during the Perioperative Period , 1993, Anesthesiology.

[2]  L. Kohn,et al.  To Err Is Human : Building a Safer Health System , 2007 .

[3]  D. Benhamou,et al.  Acid aspiration prophylaxis in obstetrics in France: a comparative survey of 1998 vs. 1988 French practice , 2004, European journal of anaesthesiology.

[4]  Y. Auroy,et al.  French survey of anesthesia in 1996. , 1999, Anesthesiology.

[5]  J. Shaoul Human Error , 1973, Nature.

[6]  Aspiration during anaesthesia: a computer‐aided study of 185 358 anaesthetics , 1986, Acta anaesthesiologica Scandinavica.

[7]  Norman E. Breslow,et al.  Case–Control Study, Two-Phase , 2005 .

[8]  David Faust,et al.  Eliminating the hindsight bias. , 1988 .

[9]  Erik Hollnagel,et al.  Cognitive reliability and error analysis method , 1998 .

[10]  James T. Reason,et al.  Safety in the operating theatre – Part 2: Human error and organisational failure , 2005 .

[11]  C. Perry,et al.  Remifentanil , 2012, Drugs.

[12]  K. Tsuzaki,et al.  Anesthesia‐related mortality and morbidity over a 5‐year period in 2,363,038 patients in Japan , 2003, Acta anaesthesiologica Scandinavica.

[13]  G. Neelakanta,et al.  A review of patients with pulmonary aspiration of gastric contents during anesthesia reported to the Departmental Quality Assurance Committee. , 2006, Journal of clinical anesthesia.

[14]  A. Møller,et al.  Pulse Oximetry for Perioperative Monitoring: Systematic Review of Randomized, Controlled Trials , 2003, Anesthesia and analgesia.

[15]  P. Barach,et al.  Five System Barriers to Achieving Ultrasafe Health Care , 2005, Annals of Internal Medicine.

[16]  Diederick E. Grobbee,et al.  Mortality associated with anaesthesia: a qualitative analysis to identify risk factors , 2001 .

[17]  D. Grobbee,et al.  Impact of Anesthesia Management Characteristics on Severe Morbidity and Mortality , 2005, Anesthesiology.

[18]  R. Lagasse,et al.  Anesthesia Safety: Model or Myth?: A Review of the Published Literature and Analysis of Current Original Data , 2002, Anesthesiology.

[19]  B. Horan,et al.  Deaths Attributed to Anaesthesia in New South Wales, 1984–1990 , 1996, Anaesthesia and intensive care.

[20]  D. Benhamou French obstetric anaesthetists and acid aspiration prophylaxis. , 1993, European journal of anaesthesiology.

[21]  K. Henriksen,et al.  Hindsight bias, outcome knowledge and adaptive learning , 2003, Quality & safety in health care.

[22]  T. Pedersen,et al.  A prospective study of mortality associated with anaesthesia and surgery: risk indicators of mortality in hospital , 1990, Acta anaesthesiologica Scandinavica.

[23]  L. Tiret,et al.  Complications Associated with Anaesthesia—A Prospective Survey in France , 1986 .

[24]  D. Hewett,et al.  How to investigate and analyse clinical incidents: Clinical Risk Unit and Association of Litigation and Risk Management protocol , 2000, BMJ : British Medical Journal.

[25]  Erik Hollnagel,et al.  Cognitive reliability and error analysis method : CREAM , 1998 .