Anesthesia Safety: Model or Myth?

Abstract

In 1999 the Institute of Medicine published a report entitled To Err is Human: Building a Safer Health Care System. In that report, the Committee on Quality of Health Care in America for the IOM asserted "Anesthesia is an area in which very ipressive improvements in safety have been made." In support of this assertion the Comittee stated that anesthesia mortality rates have decreased from 2 deaths per 10,000 cases in the 1980s to about 1 death per 200,000 to 300,000 cases today. The reference for such "impressive" gains, however, does not identify the studies that led to this conclusion. Multiple sources, including the Committe on Healthcare in America, have attributed this dramatic decrease in anesthesia mortality to a variety of mechanisms including improved monitoring techniques, the development and widepsread adoption of practice guidelines, and other systematic approaches to reducing errors. In so doing, anesthesiology has been established as a model of safety, and other specialities are encouraged to engage in similar risk reduction strategies. Because the implications of establishing anestheiology as a model of safety can have a far-reaching impact on the allocation of scarce healthcare resources, it is imperative that the basis for these claims be critically examined. Consequently, the author reviews the medical literature pertaining to anesthesia-related mortality rates published over the last 35 years, with a focus on methodology and operational definitions applied by the various investigators. More recent perioperative mortality data, collected from two university-based anesthesia practices between 1992 and 1999, are also introduced.