On a wing and a prayer: surgeons learning from the aviation industry

Surgery and aviation have many similarities. Both disciplines have made the extraordinary ordinary – involving teams of specialists using expensive equipment to perform previously unimaginable tasks in life-threatening situations. But perhaps what is most miraculous about these two astonishing human endeavours is not what they entail, but rather how frequently they occur. On any one day, an estimated 85,000 flights and 550,000 operations are completed worldwide. What are the implications of scaling up life-or-death events to such astronomical levels? One consequence of such large throughputs is that even tiny risks are magnified. If even a small percentage of patients and passengers die, this amounts to a significant number of families affected by preventable deaths. Every year around 500 people die in aviation accidents, and the World Health Organization (WHO) estimates that a staggering 1 million people die in the perioperative period,1 many due to avoidable mistakes. So, what is being done to minimize these risks?