Urgent non-emergency surgery and death attributable to anaesthetic factors

The Special Committee Investigating Deaths Under Anaesthesia in New South Wales classified 1503 deaths which occurred in the years 1984 to 1900 during, within 24 hours of, or as a result of anaesthesia. One hundred and seventy-two (11.4%) of these were attributed definitely, probably or jointly to factors under the anaesthetists' control. One hundred and forty-four (9.6%) of the 1503 deaths classified occurred in patients undergoing urgent non-emergency operations of which 45 (31.3%) were attributed to anaesthetic factors. A specialist anaesthetist either gave the anaesthetic or was present for part or all of it in 35 of these 45 cases. In 22 the hospital was a metropolitan teaching hospital. General anaesthesia was employed in 31 cases and major regional block (10 spinals and 4 epidurals) in the others. The commonest type of surgery was orthopaedic (26 cases), particularly for fractured neck of femur (20 cases). There were no deaths attributed to anaesthetic factors in cases of this degree of urgency in patients less than 16 years old. The factors under the anaesthetists' control most often identified as contributing to death were inadequate preparation for anaesthesia and surgery (18 cases, 12 of which were jointly attributed to the surgeon); inappropriate choice or application of technique (17); inadequate postoperative care (12 cases); and overdose (11 cases). If improved outcomes are to be achieved for patients having operations of this degree of urgency, greater attention must be paid to these aspects of their anaesthetic management.