United Kingdom national confidential enquiry into perioperative deaths

The enquiry (NCEPOD) was established to examine simultaneously the anaesthetic and surgical circumstances surrounding the death of a patient undergoing surgery, it reviewed clinical practice and identified remedial factors in the practice of anaesthesia and surgery in order to improve the quality of care. Data were reported on every death occurred within 30 days of a procedure performed by a surgeon or gynaecologist under general or local anaesthesia, excepting obstetric deaths, and were collected int he sample of questionnaires to surgeons and anaesthesists involved. In high risk patient the optimisation of cardiovascular system with fluids, inotropic agents, beta-blockers and invasive monitoring may improve mortality (a speculative calculation reported 1,700 out 19,000 lives saved in 1994/1995 in UK). The majority of deaths occurred in emergency operations, urgent operations delayed for no operating theatre free during the day, training personnel which performed emergency operations during the night and/or postoperative care provided by non specialized clinicians, hospital not equipped with high dependency units (HDU), surgery undertaken although the predictable infaust outcome, they were all problems outlooked by the investigation. In conclusion improvements are necessary in hospital facilities and working pattern of surgeons and anaesthesists.