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Perioperative mortality
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{{short description|Any death occurring within 30 days after surgery}} {{cs1 config|name-list-style=vanc}} '''Perioperative mortality''' has been defined as any [[death]], regardless of cause, occurring within 30 days after surgery in or out of the hospital.<ref name="mortality">{{cite journal | vauthors = Johnson ML, Gordon HS, Petersen NJ, Wray NP, Shroyer AL, Grover FL, Geraci JM | s2cid = 10839493 | title = Effect of definition of mortality on hospital profiles | journal = Medical Care | volume = 40 | issue = 1 | pages = 7β16 | date = January 2002 | pmid = 11748422 | doi = 10.1097/00005650-200201000-00003 }}</ref> Globally, 4.2 million people are estimated to die within 30 days of surgery each year.<ref name="Global burden of postoperative deat">{{cite journal | vauthors = Nepogodiev D, Martin J, Biccard B, Makupe A, Bhangu A | title = Global burden of postoperative death | language = en | journal = Lancet | volume = 393 | issue = 10170 | pages = 401 | date = February 2019 | pmid = 30722955 | doi = 10.1016/S0140-6736(18)33139-8 | doi-access = free | hdl = 20.500.11820/6088a4db-74af-4cc7-9ff4-21eb83da8d88 | hdl-access = free }}</ref> An important consideration in the decision to perform any surgical procedure is to weigh the benefits against the risks. [[Anesthesiologist]]s and [[surgeon]]s 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|date=February 2022}} ==Intraoperative causes== Immediate complications during the surgical procedure, e.g. [[bleeding]] or perforation of organs may have lethal [[sequela]]e.{{Citation needed|date=August 2011}} ==Complications following surgery== ===Infection=== {{main|Hospital-acquired 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.<ref>{{Cite book |last=Organization |first=World Health |url=https://iris.who.int/handle/10665/277399 |title=Global guidelines for the prevention of surgical site infection |date=2018 |publisher=World Health Organization |isbn=978-92-4-155047-5 |language=en}}</ref><ref>{{Cite web |date=2019-04-11 |title=Overview {{!}} Surgical site infections: prevention and treatment {{!}} Guidance {{!}} NICE |url=https://www.nice.org.uk/guidance/ng125 |access-date=2023-11-16 |website=www.nice.org.uk}}</ref><ref>{{Cite journal |last1=Gwilym |first1=Brenig L. |last2=Ambler |first2=Graeme K. |last3=Saratzis |first3=Athanasios |last4=Bosanquet |first4=David C. |last5=Stather |first5=Philip |last6=Singh |first6=Aminder |last7=Mancuso |first7=Enrico |last8=Arifi |first8=Mohedin |last9=Altabal |first9=Mohamed |last10=Elhadi |first10=Ahmed |last11=Althini |first11=Abdulmunem |last12=Ahmed |first12=Hazem |last13=Davies |first13=Huw |last14=Rangaraju |first14=Madhu |last15=Juszczak |first15=Maciej |date=August 2021 |title=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 |journal=European Journal of Vascular and Endovascular Surgery |volume=62 |issue=2 |pages=258β266 |doi=10.1016/j.ejvs.2021.05.009 |issn=1078-5884|doi-access=free |pmid=34246547 |hdl=1983/8e17b0f2-2b9e-4c7f-947b-82f0535b1ffb |hdl-access=free }}</ref><ref>{{cite journal | vauthors = Bhangu A, Ademuyiwa AO, Aguilera ML, Alexander P, Al-Saqqa SW, Borda-Luque G, etal | title = Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study | journal = The Lancet. Infectious Diseases | volume = 18 | issue = 5 | pages = 516β525 | date = May 2018 | pmid = 29452941 | pmc = 5910057 | doi = 10.1016/S1473-3099(18)30101-4 | collaboration = GlobalSurg Collaborative }}</ref> Local infection of the operative field is prevented by using [[asepsis|sterile technique]], and [[Chemoprophylaxis|prophylactic antibiotics]] are often given in abdominal surgery or patients known to have a heart defect or [[Artificial heart valve|mechanical heart valves]] that are at risk of developing [[endocarditis]].<ref>{{Cite journal |last1=Gwilym |first1=Brenig L. |last2=Dovell |first2=George |last3=Dattani |first3=Nikesh |last4=Ambler |first4=Graeme K. |last5=Shalhoub |first5=Joseph |last6=Forsythe |first6=Rachael O. |last7=Benson |first7=Ruth A. |last8=Nandhra |first8=Sandip |last9=Preece |first9=Ryan |last10=Onida |first10=Sarah |last11=Hitchman |first11=Louise |last12=Coughlin |first12=Patrick |last13=Saratzis |first13=Athanasios |last14=Bosanquet |first14=David C. |date=2021-04-01 |title=Editor's Choice β Systematic Review and Meta-Analysis of Wound Adjuncts for the Prevention of Groin Wound Surgical Site Infection in Arterial Surgery |journal=European Journal of Vascular and Endovascular Surgery |volume=61 |issue=4 |pages=636β646 |doi=10.1016/j.ejvs.2020.11.053 |issn=1078-5884|doi-access=free |pmid=33423912 |hdl=1983/47254b47-dcd3-4819-9cee-5c22a7ce7b04 |hdl-access=free }}</ref><ref>{{Cite journal |last1=Gwilym |first1=Brenig L. |last2=Ambler |first2=Graeme K. |last3=Saratzis |first3=Athanasios |last4=Bosanquet |first4=David C. |last5=Stather |first5=Philip |last6=Singh |first6=Aminder |last7=Mancuso |first7=Enrico |last8=Arifi |first8=Mohedin |last9=Altabal |first9=Mohamed |last10=Elhadi |first10=Ahmed |last11=Althini |first11=Abdulmunem |last12=Ahmed |first12=Hazem |last13=Davies |first13=Huw |last14=Rangaraju |first14=Madhu |last15=Juszczak |first15=Maciej |date=2021-08-01 |title=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 |journal=European Journal of Vascular and Endovascular Surgery |volume=62 |issue=2 |pages=258β266 |doi=10.1016/j.ejvs.2021.05.009 |issn=1078-5884|doi-access=free |pmid=34246547 |hdl=1983/8e17b0f2-2b9e-4c7f-947b-82f0535b1ffb |hdl-access=free }}</ref> 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<ref>{{cite journal |last1=Wade |first1=Ryckie G. |last2=Burr |first2=Nicholas E. |last3=McCauley |first3=Gordon |last4=Bourke |first4=Grainne |last5=Efthimiou |first5=Orestis |title=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 |journal=Annals of Surgery |date=1 September 2020 |volume= 274|issue=6 |pages=e481βe488 |doi=10.1097/SLA.0000000000004076|pmid=32773627 |doi-access=free }}</ref>), judicious use of surgical drains, prophylactic antibiotics, and vancomycin.<ref>{{cite journal | vauthors = Pahys JM, Pahys JR, Cho SK, Kang MM, Zebala LP, Hawasli AH, Sweet FA, Lee DH, Riew KD | display-authors = 6 | title = Methods to decrease postoperative infections following posterior cervical spine surgery | journal = The Journal of Bone and Joint Surgery. American Volume | volume = 95 | issue = 6 | pages = 549β54 | date = March 2013 | pmid = 23515990 | doi = 10.2106/JBJS.K.00756 }}</ref> Preventative antibiotics may also be effective.<ref>{{cite journal | vauthors = James M, Martinez EA | title = Antibiotics and perioperative infections | journal = Best Practice & Research. Clinical Anaesthesiology | volume = 22 | issue = 3 | pages = 571β84 | date = September 2008 | pmid = 18831304 | doi = 10.1016/j.bpa.2008.05.001 }}</ref> Whether any specific dressing has an effect on the risk of surgical site infection of a wound that has been sutured closed is unclear.<ref>{{cite journal | vauthors = Dumville JC, Gray TA, Walter CJ, Sharp CA, Page T, Macefield R, Blencowe N, Milne TK, Reeves BC, Blazeby J | display-authors = 6 | title = Dressings for the prevention of surgical site infection | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | pages = CD003091 | date = December 2016 | issue = 12 | pmid = 27996083 | pmc = 6464019 | doi = 10.1002/14651858.CD003091.pub4 }}</ref> A 2009 [[Cochrane (organisation)|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 trial]]s were needed to address this research question.<ref>{{cite journal | vauthors = Kao LS, Meeks D, Moyer VA, Lally KP | title = Peri-operative glycaemic control regimens for preventing surgical site infections in adults | journal = The Cochrane Database of Systematic Reviews | issue = 3 | pages = CD006806 | date = July 2009 | pmid = 19588404 | pmc = 2893384 | doi = 10.1002/14651858.cd006806.pub2 }}</ref> ===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 [[anticoagulant]]s (e.g., [[warfarin]] or [[low molecular weight heparin]]s), [[antiplatelet drug]]s (e.g., [[aspirin]]), [[compression stockings]], and [[Sequential compression device|cyclical pneumatic calf compression]] in high risk patients.{{Citation needed|date=August 2011}} ===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.) <ref>{{cite journal | vauthors = Cook MW, Lisco SJ | title = Prevention of postoperative pulmonary complications | journal = International Anesthesiology Clinics | volume = 47 | issue = 4 | pages = 65β88 | year = 2009 | pmid = 19820479 | doi = 10.1097/aia.0b013e3181ba1406 | s2cid = 9060298 }}</ref> 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.<ref name="Smetana 2006 581β595">{{cite journal | vauthors = Smetana GW, Lawrence VA, Cornell JE | title = Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American College of Physicians | journal = Annals of Internal Medicine | volume = 144 | issue = 8 | pages = 581β95 | date = April 2006 | pmid = 16618956 | doi = 10.7326/0003-4819-144-8-200604180-00009 | s2cid = 7297481 | doi-access = }}</ref> 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.<ref>{{cite journal | vauthors = Smetana GW | s2cid = 20581319 | title = Postoperative pulmonary complications: an update on risk assessment and reduction | journal = Cleveland Clinic Journal of Medicine | volume = 76 | issue = Suppl 4 | pages = S60-5 | date = November 2009 | pmid = 19880838 | doi = 10.3949/ccjm.76.s4.10 | doi-access = free }}</ref> 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.<ref name="Smetana 2006 581β595"/> [[Respiratory therapy]] has a place in preventing [[pneumonia]] related to [[atelectasis]], which occurs especially in patients recovering from thoracic and abdominal surgery.{{Citation needed|date=August 2011}}. ===Neurologic=== [[Stroke]]s occur at a higher rate during the postoperative period.{{Citation needed|date=July 2011}} ===Livers and kidneys=== In people with [[cirrhosis]], the perioperative mortality is predicted by the [[Child-Pugh score]].<ref>{{Citation |last=Tsoris |first=Andrea |title=Use Of The Child Pugh Score In Liver Disease |date=2025 |work=StatPearls |url=https://www.ncbi.nlm.nih.gov/books/NBK542308/ |access-date=2025-03-08 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=31194448 |last2=Marlar |first2=Clinton A.}}</ref> === Postoperative fever === [[Postoperative fever]]s 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|date=February 2022}} ==Epidemiology== Most perioperative mortality is attributable to [[Complication (medicine)|complications]] from the operation (such as bleeding, [[sepsis]], and failure of vital organs) or pre-existing [[Comorbidity|medical conditions]].{{Citation needed|date=September 2010}}. 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.<ref name="Global burden of postoperative deat"/> Perioperative mortality figures can be published in [[league table]]s 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.<ref name="GlobalSurg2016">{{cite journal | vauthors = Fitzgerald JE, Khatri C, Glasbey JC, Mohan M, Lilford R, Harrison EM, etal | collaboration = GlobalSurg Collaborative | title = Mortality of emergency abdominal surgery in high-, middle- and low-income countries | journal = The British Journal of Surgery | volume = 103 | issue = 8 | pages = 971β988 | date = July 2016 | pmid = 27145169 | doi = 10.1002/bjs.10151 | hdl-access = free | hdl = 20.500.11820/7c4589f5-7845-4405-a384-dfb5653e2163 | s2cid = 20764511 }}</ref> In this study the overall global mortality rate was 1Β·6 per cent at 24βhours (high HDI 1Β·1 per cent, middle HDI 1Β·9 per cent, low HDI 3Β·4 per cent), increasing to 5Β·4 per cent by 30 days (high HDI 4Β·5 per cent, middle HDI 6Β·0 per cent, low HDI 8Β·6 per cent; P < 0Β·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.<ref name=GlobalSurgPaeds2016>{{cite journal | vauthors = Ademuyiwa AO, Arnaud AP, Drake TM, Fitzgerald JE, Poenaru D, etal | collaboration = GlobalSurg Collaborative | title = Determinants of morbidity and mortality following emergency abdominal surgery in children in low-income and middle-income countries | journal = BMJ Global Health | volume = 1 | issue = 4 | pages = e000091 | year = 2016 | pmid = 28588977 | pmc = 5321375 | doi = 10.1136/bmjgh-2016-000091 }}</ref> 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,<ref name=Engelhart1999>{{cite journal | vauthors = Engelhardt T, Webster NR | title = Pulmonary aspiration of gastric contents in anaesthesia | journal = British Journal of Anaesthesia | volume = 83 | issue = 3 | pages = 453β60 | date = September 1999 | pmid = 10655918 | doi = 10.1093/bja/83.3.453 | doi-access = free }}</ref> [[asphyxia]]tion<ref name=Parker1956>{{cite journal | vauthors = Parker RB | title = Maternal death from aspiration asphyxia | journal = British Medical Journal | volume = 2 | issue = 4983 | pages = 16β9 | date = July 1956 | pmid = 13329366 | pmc = 2034767 | doi = 10.1136/bmj.2.4983.16 }}</ref> and [[anaphylaxis]].<ref name=Dewachter2009>{{cite journal | vauthors = Dewachter P, Mouton-Faivre C, Emala CW | title = Anaphylaxis and anesthesia: controversies and new insights | journal = Anesthesiology | volume = 111 | issue = 5 | pages = 1141β50 | date = November 2009 | pmid = 19858877 | doi = 10.1097/ALN.0b013e3181bbd443 | doi-access = free }}</ref> These in turn may result from malfunction of [[Instruments used in anesthesiology|anesthesia-related equipment]] or more commonly, [[Human reliability|human error]]. A 1978 study found that 82% of preventable anesthesia mishaps were the result of human error.<ref name=Cooper1978>{{cite journal | vauthors = Cooper JB, Newbower RS, Long CD, McPeek B | title = Preventable anesthesia mishaps: a study of human factors | journal = Anesthesiology | volume = 49 | issue = 6 | pages = 399β406 | date = December 1978 | pmid = 727541 | doi = 10.1097/00000542-197812000-00004 | url = http://journals.2lww.com/anesthesiology/Abstract/1978/12000/Preventable_Anesthesia_Mishaps__A_Study_of_Human.4.aspx | doi-access = free }}{{dead link|date=September 2017 |bot=InternetArchiveBot |fix-attempted=yes }}</ref> In a 1954 review of 599,548 surgical procedures at 10 hospitals in the United States between 1948{{spaced ndash}}1952, 384 deaths were attributed to anesthesia, for an overall [[mortality rate]] of 0.064%.<ref name=Beecher1954>{{cite journal | vauthors = Beecher HK, Todd DP | title = A study of the deaths associated with anesthesia and surgery: based on a study of 599, 548 anesthesias in ten institutions 1948-1952, inclusive | journal = Annals of Surgery | volume = 140 | issue = 1 | pages = 2β35 | date = July 1954 | pmid = 13159140 | pmc = 1609600 | doi = 10.1097/00000658-195407000-00001 | author-link = Henry K. Beecher }}</ref> 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]].<ref name=Guadagnino2000>{{Cite web| vauthors =Guadagnino C |title=Improving anesthesia safety |publisher=Physician's News Digest |location=Narberth, Pennsylvania |year=2000|url=http://physiciansnews.com/spotlight/200wp.html |url-status=dead|archive-url=https://web.archive.org/web/20100815080827/http://physiciansnews.com/spotlight/200wp.html|archive-date=2010-08-15}}</ref> This committee was tasked with determining and reducing the causes of peri-anesthetic [[Disease#Morbidity|morbidity]] and mortality.<ref name=Guadagnino2000/> An outgrowth of this committee, the [http://www.apsf.org/ Anesthesia Patient Safety Foundation] was created in 1985 as an independent, nonprofit corporation with the vision that "no patient shall be harmed by anesthesia".<ref name=Stoelting2010>{{cite web| vauthors=Stoelting RK|title=Foundation History |publisher=Anesthesia Patient Safety Foundation |location=Indianapolis, IN|year=2010 |url=http://www.apsf.org/about_history.php }}</ref> The current mortality attributable to the management of general anesthesia is controversial.<ref name=Cottrell2003>{{Cite journal|author=Cottrell JE|title=Uncle Sam, Anesthesia-Related Mortality and New Directions: Uncle Sam Wants You!|journal=ASA Newsletter|volume=67|issue=1|year=2003|url=http://www.asahq.org/Newsletters/2003/01_03/cottrell.html|url-status=dead|archive-url=https://web.archive.org/web/20100731031031/http://www.asahq.org/Newsletters/2003/01_03/cottrell.html|archive-date=2010-07-31}}</ref> Most current estimates of perioperative mortality range from 1 death in 53 anesthetics to 1 in 5,417 anesthetics.<ref name=Lagasse2002>{{cite journal | vauthors = Lagasse RS | s2cid = 32903609 | title = Anesthesia safety: model or myth? A review of the published literature and analysis of current original data | journal = Anesthesiology | volume = 97 | issue = 6 | pages = 1609β17 | date = December 2002 | pmid = 12459692 | doi = 10.1097/00000542-200212000-00038 | doi-access = free }}</ref><ref name=Arbous2005>{{cite journal | vauthors = Arbous MS, Meursing AE, van Kleef JW, de Lange JJ, Spoormans HH, Touw P, Werner FM, Grobbee DE | display-authors = 6 | title = Impact of anesthesia management characteristics on severe morbidity and mortality | journal = Anesthesiology | volume = 102 | issue = 2 | pages = 257β68; quiz 491β2 | date = February 2005 | pmid = 15681938 | doi = 10.1097/00000542-200502000-00005 | url = http://www.klinikum-memmingen.de/fileadmin/anaesthesie/literatur/Arbous_1.pdf | hdl = 1874/12590 }} {{Dead link|date=November 2010|bot=H3llBot}}</ref> The incidence of perioperative mortality that is directly attributable to anesthesia ranges from 1 in 6,795 to 1 in 200,200 anesthetics.<ref name=Lagasse2002/> There are some studies however that report a much lower mortality rate. For example, a 1997 Canadian [[Retrospective cohort study|retrospective review]] of 2,830,000 [[Oral surgery|oral surgical]] procedures in Ontario between 1973{{spaced ndash}}1995 reported only four deaths in cases in which either an [[Oral and maxillofacial surgery|oral and maxillofacial surgeon]] or a [[Dentistry|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.<ref name=Nkansah1997>{{cite journal | vauthors = Nkansah PJ, Haas DA, Saso MA | title = Mortality incidence in outpatient anesthesia for dentistry in Ontario | journal = Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics | volume = 83 | issue = 6 | pages = 646β51 | date = June 1997 | pmid = 9195616 | doi = 10.1016/S1079-2104(97)90312-7 | url = http://www.ooooe.net/article/S1079-2104(97)90312-7/abstract | url-access = subscription }}</ref> It is suggested that these wide ranges may be caused by differences in operational definitions and reporting sources.<ref name=Lagasse2002/> 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{{spaced ndash}}2005, postoperative mortality from all causes was observed in 67,879 patients, for an overall rate of 1.85%.<ref name=Noordzij2010>{{cite journal | vauthors = Noordzij PG, Poldermans D, Schouten O, Bax JJ, Schreiner FA, Boersma E | title = Postoperative mortality in The Netherlands: a population-based analysis of surgery-specific risk in adults | journal = Anesthesiology | volume = 112 | issue = 5 | pages = 1105β15 | date = May 2010 | pmid = 20418691 | doi = 10.1097/ALN.0b013e3181d5f95c | doi-access = free }}</ref> 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 == * [[Patient safety]] * [[ASA physical status classification system]] == References == {{reflist}} == Further reading == {{refbegin|30em}} * {{cite journal | vauthors = Deans GT, Odling-Smee W, McKelvey ST, Parks GT, Roy DA | title = Auditing perioperative mortality | journal = Annals of the Royal College of Surgeons of England | volume = 69 | issue = 4 | pages = 185β7 | date = July 1987 | pmid = 3631878 | pmc = 2498471 }} * {{cite journal | vauthors = Fong Y, Gonen M, Rubin D, Radzyner M, Brennan MF | title = Long-term survival is superior after resection for cancer in high-volume centers | journal = Annals of Surgery | volume = 242 | issue = 4 | pages = 540β4; discussion 544β7 | date = October 2005 | pmid = 16192814 | pmc = 1402350 | doi = 10.1097/01.sla.0000184190.20289.4b }} * {{cite journal | vauthors = Johnson ML, Gordon HS, Petersen NJ, Wray NP, Shroyer AL, Grover FL, Geraci JM | s2cid = 10839493 | title = Effect of definition of mortality on hospital profiles | journal = Medical Care | volume = 40 | issue = 1 | pages = 7β16 | date = January 2002 | pmid = 11748422 | doi = 10.1097/00005650-200201000-00003 | jstor = 3767954 }} * {{cite journal | vauthors = Mayo SC, Shore AD, Nathan H, Edil BH, Hirose K, Anders RA, Wolfgang CL, Schulick RD, Choti MA, Pawlik TM | display-authors = 6 | title = Refining the definition of perioperative mortality following hepatectomy using death within 90 days as the standard criterion | journal = HPB | volume = 13 | issue = 7 | pages = 473β82 | date = July 2011 | pmid = 21689231 | pmc = 3133714 | doi = 10.1111/j.1477-2574.2011.00326.x }} * {{cite journal | vauthors = Nixon SJ | title = NCEPOD: revisiting perioperative mortality | journal = BMJ | volume = 304 | issue = 6835 | pages = 1128β9 | date = May 1992 | pmid = 1392785 | pmc = 1882135 | doi = 10.1136/bmj.304.6835.1128 | url = }} * {{cite journal | vauthors = de Leon MP, Pezzi A, Benatti P, Manenti A, Rossi G, di Gregorio C, Roncucci L | s2cid = 24925839 | title = Survival, surgical management and perioperative mortality of colorectal cancer in the 21-year experience of a specialised registry | journal = International Journal of Colorectal Disease | volume = 24 | issue = 7 | pages = 777β88 | date = July 2009 | pmid = 19280201 | doi = 10.1007/s00384-009-0687-1 }} * {{cite journal | vauthors = Shaw CD | title = Perioperative and perinatal death as measures for quality assurance | journal = Quality Assurance in Health Care | volume = 2 | issue = 3β4 | pages = 235β41 | year = 1990 | pmid = 1983243 | doi = 10.1093/intqhc/2.3-4.235 }} * {{cite journal | vauthors = Simunovic N, Devereaux PJ, Bhandari M | title = Surgery for hip fractures: Does surgical delay affect outcomes? | journal = Indian Journal of Orthopaedics | volume = 45 | issue = 1 | pages = 27β32 | date = January 2011 | pmid = 21221220 | pmc = 3004074 | doi = 10.4103/0019-5413.73660 | doi-access = free }} * {{cite journal | vauthors = Start RD, Cross SS | title = Acp. Best practice no 155. Pathological investigation of deaths following surgery, anaesthesia, and medical procedures | journal = Journal of Clinical Pathology | volume = 52 | issue = 9 | pages = 640β52 | date = September 1999 | pmid = 10655984 | pmc = 501538 | doi = 10.1136/jcp.52.9.640 }} * {{cite journal | vauthors = Schermerhorn ML, Giles KA, Sachs T, Bensley RP, O'Malley AJ, Cotterill P, Landon BE | title = Defining perioperative mortality after open and endovascular aortic aneurysm repair in the US Medicare population | journal = Journal of the American College of Surgeons | volume = 212 | issue = 3 | pages = 349β55 | date = March 2011 | pmid = 21296011 | pmc = 3051838 | doi = 10.1016/j.jamcollsurg.2010.12.003 }} {{refend}} == External links == * {{cite web|author=Perioperative Mortality Review Committee, Department of Health, New Zealand|title=Terms of Reference for the Perioperative Mortality Review Committee|year=2009|url=http://www.pomrc.health.govt.nz/moh.nsf/pagescm/7722/$File/pomrc-tor-sept09.pdf}}{{Dead link|date=August 2018 |bot=InternetArchiveBot |fix-attempted=yes }} * {{cite web|title=National Confidential Enquiry into Patient Outcome and Death|url=http://www.ncepod.org.uk/}} {{DEFAULTSORT:Perioperative Mortality}} [[Category:Anesthesia]] [[Category:Causes of death]] [[Category:Complications of surgical and medical care]] [[Category:Epidemiology]] [[Category:Surgery]]
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