Mortality associated with anaesthesia in New South Wales, 1984‐1990

OBJECTIVE: To review deaths in New South Wales associated with anaesthesia from 1984 to 1990. DESIGN: The Special Committee Investigating DeathS Under Anaesthesia reviewed all deaths in NSW under anaesthesia or within 24 hours of anaesthesia in which complete recovery from anaesthesia did not occur. FINDINGS: The Committee reviewed 1503 deaths in some 3.5 million surgical procedures. In 60% the patient's death was considered to be inevitable and in 4% fortuitous. Factors under the control of the anaesthetist caused or significantly contributed to the fatal outcome in 172 cases (11%). Factors under the control of the surgeon caused or significantly contributed to the fatal outcome in 421 cases (28%). In 191 of the 421 deaths related to surgical factors and 11 of the 172 deaths related to anaesthetic factors, no better alternative procedure was considered possible and the procedures were properly performed. In only one death in a child under 10 years and in two obstetric fatalities was the anaesthetic management considered to have contributed to the outcome. Three quarters of the deaths were related to abdominal, cardiothoracic or vascular surgery, and 70% were related to emergency procedures. Male deaths outnumbered female 1.7:1. The mortality rate was 4.4 per 10,000 operations, with a male: female ratio of more than 2:1. Trauma in the 20-29 age group and vascular and cardiothoracic surgery in the 50-79 age group were mainly responsible for the sex difference in the number of deaths, but the difference was also seen in other surgical groups. CONCLUSIONS: From 1984 to 1990, deaths in which factors under the control of the anaesthetist caused or contributed to the fatal outcome occurred at a rate of 1 in 20,000 operations. This figure compares favourably with a rate of 1 in 5500 operations in NSW in 1960 and 1 in 10,250 operations in 1970.