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A845
October 20, 2008 8:00 AM - 10:00 AM Room Room 230A |
| Epidemiology of Anesthesia-Related Deaths in the United States, 1999-2004 |
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Guohua Li, Ph.D., M.D., Margaret Warner, Ph.D., Barbara Lang, B.S., Lin Huang, M.S., Lena Sun, M.D. Anesthesiology, Columbia University, New York, NY |
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Background: Mortality risk associated with anesthesia has been studied extensively for many decades. Previous research is limited to case reports, closed claims, and data from individual hospitals. Little is known about the magnitude and epidemiological patterns of anesthesia-related deaths at the population level. The objectives of this study are to develop a standard set of anesthesia safety indicators based on the International Classification of Diseases (ICD) codes and apply these indicators to a national data system for understanding the epidemiology of anesthesia-related mortality. Methods: The patient safety indicators developed by the Agency for Healthcare Research and Quality were reviewed and the ICD-9 and ICD-10 manuals were screened to identify all the codes that are specifically attributed to anesthesia or anesthetics. The selected ICD-10 codes were applied to the multi-cause-of-death data system (a census of death certificates maintained by the National Center for Health Statistics) to identify anesthesia-related deaths in the US for the years 1999-2004. Annual mortality rates per 100,000 population were calculated according to age, sex, and specific complications. Results: The anesthesia safety indicators are composed of four categories of ICD-10 codes: 1) complications of anesthesia during pregnancy, labor, and puerperium (O29.0-O29.9, O74.0-O74.9, O89.0-O89.9); 2) overdose of anesthetics (T41.0-T41.4); 3) other complications of anesthesia (T88.2-T88.5); and 4) adverse effect of anesthetics in therapeutic use (Y45.0, Y47.1, Y48.0-Y48.4, Y55.1, Y65.3). There were a total of 1,938 anesthesia-related deaths during the 6-year study period in the US, yielding an annual mortality rate of 0.11 deaths per 100,000 population. Anesthesia complications were listed as the underlying cause of death in 205 (11%) of the cases, and as a contributing cause of death in the remaining cases. Nearly half (47%) of anesthesia-related deaths were attributed to overdose of anesthetics and an additional 42% to adverse effects of anesthetics in therapeutic use. Anesthesia-related mortality rate for men was about twice the rate for women and increased markedly after age 65 (Fig. 1).[figure1]Conclusions: The ICD system contains adequate information for identifying cases of specific anesthesia complications. The selected ICD codes can be used as anesthesia safety indicators and applied to national health information systems to monitor anesthesia-related mortality and morbidity. Each year in the US, anesthesia complications are attributed to approximately 323 deaths, with excess mortality in the elderly and men. Anesthesiology 2008; 109 A845 |
Figure 1
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