Anesthetic deaths in a developing country

It is important to ascertain the contribution of anesthesia to perioperative mortality in order to enable improvement in the safety and quality of care. Scanty literature regarding anesthetic mortality from developing countries is available. We present data regarding anesthesia related mortality in a university hospital in a developing country. We reviewed all patient deaths occurring between 1992-2003 occurring within 24 hours of anesthesia, as part of departmental quality assurance activity. The aim of study was to identify any contributing factors associated with mortality, and to compare our data with similar studies from developed and developing countries. 111,289 cases were handled in this period. Within 24 hours the crude mortality was 35 (3.14: 10,000). 3 patients died at induction, 13 intraoperatively and one at emergence. In the postoperative period 18 (51%) cases of mortality occurred. In 4 (11%) cases anesthesia was found to be solely responsible (0.35 per 10,000), in 8 (23%) cases anesthesia was found to be partially responsible (0.7 per 10,000). In 23 patient disease and surgical factors played a primary role. In 10 (28.5%) cases deaths were considered to be avoidable. Two time periods were also compared. Between 1992-1998 anesthesia mortality was 0.68: 10,000 anesthetics, and from 1999-2003 it was 0.18: 10,000 Higher mortality was observed with advancing age, higher ASA status, emergency and complex surgical procedures. Human factor, human error, inadequate preoperative preparation, inappropriate postoperative care and lack of supervision were identified as preventable factors.