Perioperative mortality

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Perioperative mortality has been defined as any death, regardless of cause, occurring within 30 days after surgery in or out of the hospital. [1] Globally, 4.2 million people are estimated to die within 30 days of surgery each year. [2] An important consideration in the decision to perform any surgical procedure is to weigh the benefits against the risks. Anesthesiologists and surgeons employ various methods in assessing whether a patient is in optimal condition from a medical standpoint prior to undertaking surgery, and various statistical tools are available. ASA score is the most well known of these.[ citation needed ]

Contents

Intraoperative causes

Immediate complications during the surgical procedure, e.g. bleeding or perforation of organs may have lethal sequelae.[ citation needed ]

Complications following surgery

Infection

Countries with a low human development index (HDI) carry a disproportionately greater burden of surgical site infections (SSI) than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of the World Health Organization (WHO) recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication. [3] [4] [5] [6]

Local infection of the operative field is prevented by using sterile technique, and prophylactic antibiotics are often given in abdominal surgery or patients known to have a heart defect or mechanical heart valves that are at risk of developing endocarditis. [7] [8]

Methods to decrease surgical site infections in spine surgery include the application of antiseptic skin preparation (a.g. Chlorhexidine gluconate in alcohol which is twice as effective as any other antiseptic for reducing the risk of infection [9] ), use of surgical drains, prophylactic antibiotics, and vancomycin. [10] Preventative antibiotics may also be effective. [11]

Whether any specific dressing has an effect on the risk of surgical site infection of a wound that has been sutured closed is unclear. [12]

A 2009 Cochrane systematic review aimed to assess the effects of strict blood glucose control around the time of operation to prevent SSIs. The authors concluded that there was insufficient evidence to support the routine adoption of this practice and that more randomized controlled trials were needed to address this research question. [13]

Blood clots

Examples are deep vein thrombosis and pulmonary embolism, the risk of which can be mitigated by certain interventions, such as the administration of anticoagulants (e.g., warfarin or low molecular weight heparins), antiplatelet drugs (e.g., aspirin), compression stockings, and cyclical pneumatic calf compression in high risk patients.[ citation needed ]

Lungs

Many factors can influence the risk of postoperative pulmonary complications (PPC). (A major PPC can be defined as a postoperative pneumonia, respiratory failure, or the need for reintubation after extubation at the end of an anesthetic. Minor post-operative pulmonary complications include events such as atelectasis, bronchospasm, laryngospasm, and unanticipated need for supplemental oxygen therapy after the initial postoperative period.) [14] Of all patient-related risk factors, good evidence supports patients with advanced age, ASA class II or greater, functional dependence, chronic obstructive pulmonary disease, and congestive heart failure, as those with increased risk for PPC. [15] Of operative risk factors, surgical site is the most important predictor of risk for PPCs (aortic, thoracic, and upper abdominal surgeries being the highest-risk procedures, even in healthy patients. [16] The value of preoperative testing, such as spirometry, to estimate pulmonary risk is of controversial value and is debated in medical literature. Among laboratory tests, a serum albumin level less than 35 g/L is the most powerful predictor and predicts PPC risk to a similar degree as the most important patient-related risk factors. [15]

Respiratory therapy has a place in preventing pneumonia related to atelectasis, which occurs especially in patients recovering from thoracic and abdominal surgery.[ citation needed ].

Neurologic

Strokes occur at a higher rate during the postoperative period.[ citation needed ]

Livers and kidneys

In people with cirrhosis, the perioperative mortality is predicted by the Child-Pugh score.[ citation needed ]

Postoperative fever

Postoperative fevers are a common complication after surgery and can be a hallmark of a serious underlying sepsis, such as pneumonia, urinary tract infection, deep vein thrombosis, wound infection, etc. However, in the early post-operative period a low-level fever may also result from anaesthetic-related atelectasis, which will usually resolve normally.[ citation needed ]

Epidemiology

Most perioperative mortality is attributable to complications from the operation (such as bleeding, sepsis, and failure of vital organs) or pre-existing medical conditions.[ citation needed ]. Although in some high-resource health care systems, statistics are kept by mandatory reporting of perioperative mortality, this is not done in most countries. For this reason a figure for total global perioperative mortality can only be estimated. A study based on extrapolation from existing data sources estimated that 4.2 million people die within 30 days of surgery every year, with half of these deaths occurring in low- and middle-income countries. [2]

Perioperative mortality figures can be published in league tables that compare the quality of hospitals. Critics of this system point out that perioperative mortality may not reflect poor performance but could be caused by other factors, e.g. a high proportion of acute/unplanned surgery, or other patient-related factors. Most hospitals have regular meetings to discuss surgical complications and perioperative mortality. Specific cases may be investigated more closely if a preventable cause has been identified.

Globally, there are few studies comparing perioperative mortality across different health systems. One prospective study of 10,745 adult patients undergoing emergency abdominal surgery from 357 centres across 58 countries found that mortality is three times higher in low- compared with high-human development index (HDI) countries even when adjusted for prognostic factors. [17] In this study the overall global mortality rate was 1·6 per cent at 24 hours (high HDI 1·1 per cent, middle HDI 1·9 per cent, low HDI 3·4 per cent), increasing to 5·4 per cent by 30 days (high HDI 4·5 per cent, middle HDI 6·0 per cent, low HDI 8·6 per cent; P < 0·001). A sub-study of 1,409 children undergoing emergency abdominal surgery from 253 centres across 43 countries found that adjusted mortality in children following surgery may be as high as 7 times greater in low-HDI and middle-HDI countries compared with high-HDI countries. This translate to 40 excess deaths per 1000 procedures performed in these settings. [18] Patient safety factors were suggested to play an important role, with use of the WHO Surgical Safety Checklist associated with reduced mortality at 30 days.

Mortality directly related to anesthetic management is less common, and may include such causes as pulmonary aspiration of gastric contents, [19] asphyxiation [20] and anaphylaxis. [21] These in turn may result from malfunction of anesthesia-related equipment or more commonly, human error. A 1978 study found that 82% of preventable anesthesia mishaps were the result of human error. [22]

In a 1954 review of 599,548 surgical procedures at 10 hospitals in the United States between 1948 –1952, 384 deaths were attributed to anesthesia, for an overall mortality rate of 0.064%. [23] In 1984, after a television program highlighting anesthesia mishaps aired in the United States, American anesthesiologist Ellison C. Pierce appointed a committee called the Anesthesia Patient Safety and Risk Management Committee of the American Society of Anesthesiologists. [24] This committee was tasked with determining and reducing the causes of peri-anesthetic morbidity and mortality. [24] An outgrowth of this committee, the Anesthesia Patient Safety Foundation was created in 1985 as an independent, nonprofit corporation with the vision that "no patient shall be harmed by anesthesia". [25]

The current mortality attributable to the management of general anesthesia is controversial. [26] Most current estimates of perioperative mortality range from 1 death in 53 anesthetics to 1 in 5,417 anesthetics. [27] [28] The incidence of perioperative mortality that is directly attributable to anesthesia ranges from 1 in 6,795 to 1 in 200,200 anesthetics. [27] There are some studies however that report a much lower mortality rate. For example, a 1997 Canadian retrospective review of 2,830,000 oral surgical procedures in Ontario between 1973 –1995 reported only four deaths in cases in which either an oral and maxillofacial surgeon or a dentist with specialized training in anesthesia administered the general anesthetic or deep sedation. The authors calculated an overall mortality rate of 1.4 per 1,000,000. [29] It is suggested that these wide ranges may be caused by differences in operational definitions and reporting sources. [27]

The largest study of postoperative mortality was published in 2010. In this review of 3.7 million surgical procedures at 102 hospitals in the Netherlands during 1991 –2005, postoperative mortality from all causes was observed in 67,879 patients, for an overall rate of 1.85%. [30]

Anaesthesiologists are committed to continuously reducing perioperative mortality and morbidity. In 2010, the principal European anaesthesiology organisations launched The Helsinki Declaration for Patient Safety in Anaesthesiology, a practically based manifesto for improving anaesthesia care in Europe.

See also

Related Research Articles

The term abdominal surgery broadly covers surgical procedures that involve opening the abdomen (laparotomy). Surgery of each abdominal organ is dealt with separately in connection with the description of that organ Diseases affecting the abdominal cavity are dealt with generally under their own names.

<span class="mw-page-title-main">Anesthesia</span> State of medically-controlled temporary loss of sensation or awareness

Anesthesia or anaesthesia is a state of controlled, temporary loss of sensation or awareness that is induced for medical or veterinary purposes. It may include some or all of analgesia, paralysis, amnesia, and unconsciousness. An individual under the effects of anesthetic drugs is referred to as being anesthetized.

A laparotomy is a surgical procedure involving a surgical incision through the abdominal wall to gain access into the abdominal cavity. It is also known as a celiotomy.

<span class="mw-page-title-main">General anaesthesia</span> Medically induced loss of consciousness

General anaesthesia (UK) or general anesthesia (US) is a method of medically inducing loss of consciousness that renders a patient unarousable even with painful stimuli. This effect is achieved by administering either intravenous or inhalational general anaesthetic medications, which often act in combination with an analgesic and neuromuscular blocking agent. Spontaneous ventilation is often inadequate during the procedure and intervention is often necessary to protect the airway. General anaesthesia is generally performed in an operating theater to allow surgical procedures that would otherwise be intolerably painful for a patient, or in an intensive care unit or emergency department to facilitate endotracheal intubation and mechanical ventilation in critically ill patients. Depending on the procedure, general anaesthesia may be optional or required. Regardless of whether a patient may prefer to be unconscious or not, certain pain stimuli could result in involuntary responses from the patient that may make an operation extremely difficult. Thus, for many procedures, general anaesthesia is required from a practical perspective.

<span class="mw-page-title-main">Spinal anaesthesia</span> Form of neuraxial regional anaesthesia

Spinal anaesthesia, also called spinal block, subarachnoid block, intradural block and intrathecal block, is a form of neuraxial regional anaesthesia involving the injection of a local anaesthetic or opioid into the subarachnoid space, generally through a fine needle, usually 9 cm (3.5 in) long. It is a safe and effective form of anesthesia usually performed by anesthesiologists that can be used as an alternative to general anesthesia commonly in surgeries involving the lower extremities and surgeries below the umbilicus. The local anesthetic with or without an opioid injected into the cerebrospinal fluid provides locoregional anaesthesia: true analgesia, motor, sensory and autonomic (sympathetic) blockade. Administering analgesics in the cerebrospinal fluid without a local anaesthetic produces locoregional analgesia: markedly reduced pain sensation, some autonomic blockade, but no sensory or motor block. Locoregional analgesia, due to mainly the absence of motor and sympathetic block may be preferred over locoregional anaesthesia in some postoperative care settings. The tip of the spinal needle has a point or small bevel. Recently, pencil point needles have been made available.

<span class="mw-page-title-main">Anesthetic</span> Drug that causes anesthesia

An anesthetic or anaesthetic is a drug used to induce anesthesia ⁠— ⁠in other words, to result in a temporary loss of sensation or awareness. They may be divided into two broad classes: general anesthetics, which result in a reversible loss of consciousness, and local anesthetics, which cause a reversible loss of sensation for a limited region of the body without necessarily affecting consciousness.

Awareness under anesthesia, also referred to as intraoperative awareness or accidental awareness during general anesthesia (AAGA), is a rare complication of general anesthesia where patients regain varying levels of consciousness during their surgical procedures. While anesthesia awareness is possible without resulting in any long-term memory of the experience, it is also possible for victims to have awareness with explicit recall, where they can remember the events related to their surgery.

Postoperative nausea and vomiting (PONV) is the phenomenon of nausea, vomiting, or retching experienced by a patient in the post-anesthesia care unit (PACU) or within 24 hours following a surgical procedure. PONV affects about 10% of the population undergoing general anaesthesia each year. PONV can be unpleasant and lead to a delay in mobilization and food, fluid, and medication intake following surgery.

<span class="mw-page-title-main">Aortic aneurysm</span> Excessive enlargement of the human aorta

An aortic aneurysm is an enlargement (dilatation) of the aorta to greater than 1.5 times normal size. They usually cause no symptoms except when ruptured. Occasionally, there may be abdominal, back, or leg pain. The prevalence of abdominal aortic aneurysm ("AAA") has been reported to range from 2 to 12% and is found in about 8% of men more than 65 years of age. The mortality rate attributable to AAA is about 15,000 per year in the United States and 6,000 to 8,000 per year in the United Kingdom and Ireland. Between 2001 and 2006, there were approximately 230,000 AAA surgical repairs performed on Medicare patients in the United States.

<span class="mw-page-title-main">Epidural administration</span> Medication injected into the epidural space of the spine

Epidural administration is a method of medication administration in which a medicine is injected into the epidural space around the spinal cord. The epidural route is used by physicians and nurse anesthetists to administer local anesthetic agents, analgesics, diagnostic medicines such as radiocontrast agents, and other medicines such as glucocorticoids. Epidural administration involves the placement of a catheter into the epidural space, which may remain in place for the duration of the treatment. The technique of intentional epidural administration of medication was first described in 1921 by Spanish military surgeon Fidel Pagés.

<span class="mw-page-title-main">Nerve block</span> Deliberate inhibition of nerve impulses

Nerve block or regional nerve blockade is any deliberate interruption of signals traveling along a nerve, often for the purpose of pain relief. Local anesthetic nerve block is a short-term block, usually lasting hours or days, involving the injection of an anesthetic, a corticosteroid, and other agents onto or near a nerve. Neurolytic block, the deliberate temporary degeneration of nerve fibers through the application of chemicals, heat, or freezing, produces a block that may persist for weeks, months, or indefinitely. Neurectomy, the cutting through or removal of a nerve or a section of a nerve, usually produces a permanent block. Because neurectomy of a sensory nerve is often followed, months later, by the emergence of new, more intense pain, sensory nerve neurectomy is rarely performed.

A post-anesthesia care unit (PACU) and sometimes referred to as post-anesthesia recovery or PAR, or simply recovery, is a part of hospitals, ambulatory care centers, and other medical facilities. Patients who received general anesthesia, regional anesthesia, or local anesthesia are transferred from the operating room suites to the recovery area. The patients are monitored typically by anesthesiologists, nurse anesthetists, and other medical staff. Providers follow a standardized handoff to the medical PACU staff that includes, which medications were given in the operating room suites, how hemodynamics were during the procedures, and what is expected for their recovery. After initial assessment and stabilization, patients are monitored for any potential complications, until the patient is transferred back to their hospital rooms.

Postoperative cognitive dysfunction (POCD) is a decline in cognitive function that may last from 1–12 months after surgery, or longer. In some cases, this disorder may persist for several years after major surgery. POCD is distinct from emergence delirium. Its causes are under investigation and occurs commonly in older patients and those with pre-existing cognitive impairment.

The ASA physical status classification system is a system for assessing the fitness of patients before surgery. In 1963 the American Society of Anesthesiologists (ASA) adopted the five-category physical status classification system; a sixth category was later added. These are:

  1. Healthy person.
  2. Mild systemic disease.
  3. Severe systemic disease.
  4. Severe systemic disease that is a constant threat to life.
  5. A moribund person who is not expected to survive without the operation.
  6. A declared brain-dead person whose organs are being removed for donor purposes.

The Outcomes Research Consortium is an international clinical research group that focuses on the perioperative period, along with critical care and pain management. The Consortium's aim is to improve the quality of care for surgical, critical care, and chronic pain patients and to "Provide the evidence for evidence-based practice." Members of the Consortium are especially interested in testing simple, low-risk, and inexpensive treatments that have the potential to markedly improve patients' surgical experiences.

Continuous wound infiltration (CWI) refers to the continuous infiltration of a local anesthetic into a surgical wound to aid in pain management during post-operative recovery.

<span class="mw-page-title-main">Brachial plexus block</span>

Brachial plexus block is a regional anesthesia technique that is sometimes employed as an alternative or as an adjunct to general anesthesia for surgery of the upper extremity. This technique involves the injection of local anesthetic agents in close proximity to the brachial plexus, temporarily blocking the sensation and ability to move the upper extremity. The subject can remain awake during the ensuing surgical procedure, or they can be sedated or even fully anesthetized if necessary.

<span class="mw-page-title-main">Open aortic surgery</span> Surgical technique

Open aortic surgery (OAS), also known as open aortic repair (OAR), describes a technique whereby an abdominal, thoracic or retroperitoneal surgical incision is used to visualize and control the aorta for purposes of treatment, usually by the replacement of the affected segment with a prosthetic graft. OAS is used to treat aneurysms of the abdominal and thoracic aorta, aortic dissection, acute aortic syndrome, and aortic ruptures. Aortobifemoral bypass is also used to treat atherosclerotic disease of the abdominal aorta below the level of the renal arteries. In 2003, OAS was surpassed by endovascular aneurysm repair (EVAR) as the most common technique for repairing abdominal aortic aneurysms in the United States.

Postoperative wounds are those wounds acquired during surgical procedures. Postoperative wound healing occurs after surgery and normally follows distinct bodily reactions: the inflammatory response, the proliferation of cells and tissues that initiate healing, and the final remodeling. Postoperative wounds are different from other wounds in that they are anticipated and treatment is usually standardized depending on the type of surgery performed. Since the wounds are 'predicted' actions can be taken beforehand and after surgery that can reduce complications and promote healing.

<span class="mw-page-title-main">Caudal anaesthesia</span> Form of neuraxial regional anaesthesia

Caudal anaesthesia is a form of neuraxial regional anaesthesia conducted by accessing the epidural space via the sacral hiatus. It is typically used in paediatrics to provide peri- and post-operative analgesia for surgeries below the umbilicus. In adults, it can be used in the context of anorectal surgery or for chronic low back pain management.

References

  1. ↑ Johnson ML, Gordon HS, Petersen NJ, Wray NP, Shroyer AL, Grover FL, Geraci JM (January 2002). "Effect of definition of mortality on hospital profiles". Medical Care. 40 (1): 7–16. doi:10.1097/00005650-200201000-00003. PMID   11748422. S2CID   10839493.
  2. 1 2 Nepogodiev D, Martin J, Biccard B, Makupe A, Bhangu A (February 2019). "Global burden of postoperative death". Lancet. 393 (10170): 401. doi: 10.1016/S0140-6736(18)33139-8 . hdl: 20.500.11820/6088a4db-74af-4cc7-9ff4-21eb83da8d88 . PMID   30722955.
  3. ↑ Organization WH (2018). Global guidelines for the prevention of surgical site infection. World Health Organization. ISBN   978-92-4-155047-5.
  4. ↑ "Overview | Surgical site infections: prevention and treatment | Guidance | NICE". www.nice.org.uk. 2019-04-11. Retrieved 2023-11-16.
  5. ↑ Gwilym BL, Ambler GK, Saratzis A, Bosanquet DC, Stather P, Singh A, Mancuso E, Arifi M, Altabal M, Elhadi A, Althini A, Ahmed H, Davies H, Rangaraju M, Juszczak M (August 2021). "Groin Wound Infection after Vascular Exposure (GIVE) Risk Prediction Models: Development, Internal Validation, and Comparison with Existing Risk Prediction Models Identified in a Systematic Literature Review". European Journal of Vascular and Endovascular Surgery. 62 (2): 258–266. doi: 10.1016/j.ejvs.2021.05.009 . hdl: 1983/8e17b0f2-2b9e-4c7f-947b-82f0535b1ffb . ISSN   1078-5884. PMID   34246547.
  6. ↑ Bhangu A, Ademuyiwa AO, Aguilera ML, Alexander P, Al-Saqqa SW, Borda-Luque G, et al. (GlobalSurg Collaborative) (May 2018). "Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study". The Lancet. Infectious Diseases. 18 (5): 516–525. doi:10.1016/S1473-3099(18)30101-4. PMC   5910057 . PMID   29452941.
  7. ↑ Gwilym BL, Dovell G, Dattani N, Ambler GK, Shalhoub J, Forsythe RO, Benson RA, Nandhra S, Preece R, Onida S, Hitchman L, Coughlin P, Saratzis A, Bosanquet DC (2021-04-01). "Editor's Choice – Systematic Review and Meta-Analysis of Wound Adjuncts for the Prevention of Groin Wound Surgical Site Infection in Arterial Surgery". European Journal of Vascular and Endovascular Surgery. 61 (4): 636–646. doi: 10.1016/j.ejvs.2020.11.053 . hdl: 1983/47254b47-dcd3-4819-9cee-5c22a7ce7b04 . ISSN   1078-5884. PMID   33423912.
  8. ↑ Gwilym BL, Ambler GK, Saratzis A, Bosanquet DC, Stather P, Singh A, Mancuso E, Arifi M, Altabal M, Elhadi A, Althini A, Ahmed H, Davies H, Rangaraju M, Juszczak M (2021-08-01). "Groin Wound Infection after Vascular Exposure (GIVE) Risk Prediction Models: Development, Internal Validation, and Comparison with Existing Risk Prediction Models Identified in a Systematic Literature Review". European Journal of Vascular and Endovascular Surgery. 62 (2): 258–266. doi: 10.1016/j.ejvs.2021.05.009 . hdl: 1983/8e17b0f2-2b9e-4c7f-947b-82f0535b1ffb . ISSN   1078-5884. PMID   34246547.
  9. ↑ Wade RG, Burr NE, McCauley G, Bourke G, Efthimiou O (1 September 2020). "The Comparative Efficacy of Chlorhexidine Gluconate and Povidone-iodine Antiseptics for the Prevention of Infection in Clean Surgery: A Systematic Review and Network Meta-analysis". Annals of Surgery. 274 (6): e481–e488. doi: 10.1097/SLA.0000000000004076 . PMID   32773627.
  10. ↑ Pahys JM, Pahys JR, Cho SK, Kang MM, Zebala LP, Hawasli AH, et al. (March 2013). "Methods to decrease postoperative infections following posterior cervical spine surgery". The Journal of Bone and Joint Surgery. American Volume. 95 (6): 549–54. doi:10.2106/JBJS.K.00756. PMID   23515990.
  11. ↑ James M, Martinez EA (September 2008). "Antibiotics and perioperative infections". Best Practice & Research. Clinical Anaesthesiology. 22 (3): 571–84. doi:10.1016/j.bpa.2008.05.001. PMID   18831304.
  12. ↑ Dumville JC, Gray TA, Walter CJ, Sharp CA, Page T, Macefield R, et al. (December 2016). "Dressings for the prevention of surgical site infection". The Cochrane Database of Systematic Reviews. 2016 (12): CD003091. doi:10.1002/14651858.CD003091.pub4. PMC   6464019 . PMID   27996083.
  13. ↑ Kao LS, Meeks D, Moyer VA, Lally KP (July 2009). "Peri-operative glycaemic control regimens for preventing surgical site infections in adults". The Cochrane Database of Systematic Reviews (3): CD006806. doi:10.1002/14651858.cd006806.pub2. PMC   2893384 . PMID   19588404.
  14. ↑ Cook MW, Lisco SJ (2009). "Prevention of postoperative pulmonary complications". International Anesthesiology Clinics. 47 (4): 65–88. doi:10.1097/aia.0b013e3181ba1406. PMID   19820479. S2CID   9060298.
  15. 1 2 Smetana GW, Lawrence VA, Cornell JE (April 2006). "Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American College of Physicians". Annals of Internal Medicine. 144 (8): 581–95. doi:10.7326/0003-4819-144-8-200604180-00009. PMID   16618956. S2CID   7297481.
  16. ↑ Smetana GW (November 2009). "Postoperative pulmonary complications: an update on risk assessment and reduction". Cleveland Clinic Journal of Medicine. 76 (Suppl 4): S60-5. doi: 10.3949/ccjm.76.s4.10 . PMID   19880838. S2CID   20581319.
  17. ↑ Fitzgerald JE, Khatri C, Glasbey JC, Mohan M, Lilford R, Harrison EM, et al. (GlobalSurg Collaborative) (July 2016). "Mortality of emergency abdominal surgery in high-, middle- and low-income countries". The British Journal of Surgery. 103 (8): 971–988. doi:10.1002/bjs.10151. hdl: 20.500.11820/7c4589f5-7845-4405-a384-dfb5653e2163 . PMID   27145169. S2CID   20764511.
  18. ↑ Ademuyiwa AO, Arnaud AP, Drake TM, Fitzgerald JE, Poenaru D, et al. (GlobalSurg Collaborative) (2016). "Determinants of morbidity and mortality following emergency abdominal surgery in children in low-income and middle-income countries". BMJ Global Health. 1 (4): e000091. doi:10.1136/bmjgh-2016-000091. PMC   5321375 . PMID   28588977.
  19. ↑ Engelhardt T, Webster NR (September 1999). "Pulmonary aspiration of gastric contents in anaesthesia". British Journal of Anaesthesia. 83 (3): 453–60. doi: 10.1093/bja/83.3.453 . PMID   10655918.
  20. ↑ Parker RB (July 1956). "Maternal death from aspiration asphyxia". British Medical Journal. 2 (4983): 16–9. doi:10.1136/bmj.2.4983.16. PMC   2034767 . PMID   13329366.
  21. ↑ Dewachter P, Mouton-Faivre C, Emala CW (November 2009). "Anaphylaxis and anesthesia: controversies and new insights". Anesthesiology. 111 (5): 1141–50. doi: 10.1097/ALN.0b013e3181bbd443 . PMID   19858877.
  22. ↑ Cooper JB, Newbower RS, Long CD, McPeek B (December 1978). "Preventable anesthesia mishaps: a study of human factors". Anesthesiology. 49 (6): 399–406. doi: 10.1097/00000542-197812000-00004 . PMID   727541.[ permanent dead link ]
  23. ↑ Beecher HK, Todd DP (July 1954). "A study of the deaths associated with anesthesia and surgery: based on a study of 599, 548 anesthesias in ten institutions 1948-1952, inclusive". Annals of Surgery. 140 (1): 2–35. doi:10.1097/00000658-195407000-00001. PMC   1609600 . PMID   13159140.
  24. 1 2 Guadagnino C (2000). "Improving anesthesia safety". Narberth, Pennsylvania: Physician's News Digest. Archived from the original on 2010-08-15.
  25. ↑ Stoelting RK (2010). "Foundation History". Indianapolis, IN: Anesthesia Patient Safety Foundation.
  26. ↑ Cottrell JE (2003). "Uncle Sam, Anesthesia-Related Mortality and New Directions: Uncle Sam Wants You!". ASA Newsletter. 67 (1). Archived from the original on 2010-07-31.
  27. 1 2 3 Lagasse RS (December 2002). "Anesthesia safety: model or myth? A review of the published literature and analysis of current original data". Anesthesiology. 97 (6): 1609–17. doi: 10.1097/00000542-200212000-00038 . PMID   12459692. S2CID   32903609.
  28. ↑ Arbous MS, Meursing AE, van Kleef JW, de Lange JJ, Spoormans HH, Touw P, et al. (February 2005). "Impact of anesthesia management characteristics on severe morbidity and mortality" (PDF). Anesthesiology. 102 (2): 257–68, quiz 491–2. doi:10.1097/00000542-200502000-00005. hdl:1874/12590. PMID   15681938.[ dead link ]
  29. ↑ Nkansah PJ, Haas DA, Saso MA (June 1997). "Mortality incidence in outpatient anesthesia for dentistry in Ontario". Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics. 83 (6): 646–51. doi:10.1016/S1079-2104(97)90312-7. PMID   9195616.
  30. ↑ Noordzij PG, Poldermans D, Schouten O, Bax JJ, Schreiner FA, Boersma E (May 2010). "Postoperative mortality in The Netherlands: a population-based analysis of surgery-specific risk in adults". Anesthesiology. 112 (5): 1105–15. doi: 10.1097/ALN.0b013e3181d5f95c . PMID   20418691.

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