Safety of Anaesthesia

Anaesthesia in Australia and New Zealand has never been safer for our patients. This is due to constant improvements in anaesthetists’ skills and knowledge, the development of increasingly effective monitoring and interventions, and the ongoing evaluation of outcomes. Safety of Anaesthesia: A review of anaesthesiarelated mortality reporting in Australia and New Zealand 2012-2014 is the 10th triennial report of anaesthesia-related mortality from ANZCA, and continues almost 30 years of reporting in this area. This report contains data from six Australian states (New South Wales, Victoria, Western Australia, Tasmania, South Australia and Queensland). This represents a large proportion of the Australian population and can thus be considered a reasonable estimate of anaesthetic mortality for this period, covering 11.4 million episodes of anaesthesia. It equates to an anaesthesia mortality rate of just under three deaths per million population per annum, which is very similar to the figures for the previous two trienniums (2006-11) – even though these covered fewer states. The anaesthesia-related mortality per episode of anaesthesia was 1:57,023. For New Zealand, the Perioperative Mortality Review Committee (POMRC) provided data on 30-day mortality. A consistent trend has been an increase in the proportion of these deaths which are considered to be related to the patient’s underlying medical condition, and a reduction in contributory factors from anaesthesia. This reflects improvements in anaesthesia practice standards but also the increasing age and complexity of cases being managed. The elderly and emergency cases continue to be at higher risk. Identified in the New Zealand POMRC reports is the heightened risk of 30-day mortality in patients operated on out of normal working hours, whether elective or emergency. Areas of anaesthetic practice in interventional medicine, such as endoscopy and radiology, are identified as high risk, as in the previous triennium. This is an ongoing area of concern for the college. Deaths due to anaphylaxis and cardiac arrest continue to occur, and reflect the importance of maintaining ongoing training in skilled diagnosis and resuscitation. Reporting and critical review of perioperative mortality is a responsibility of our profession. The efforts of all involved in compiling this new report, in particular its editor, Associate Professor Larry McNicol, the mortality committees, and the reporting anaesthetists are gratefully acknowledged along with the support from coroners’ offices. This is an important document. Please read it thoroughly and consider the findings in your practice and the hospitals that you work in.