Longnecker's Anesthesiology > Part 3. Safety and Risk Reduction in Anesthesia Practice > Chapter 24. Anesthesia Risk Fredrick K. Orkin, MD, MBA, MSc, and David E. Longnecker, MD, FRCA

Key Points

"1. Anesthesia risk estimates are wholly dependent on the circumstances in which they are generated; estimates developed in one clinical setting or selected population may not be relevant to other settings or specific patients.

2. The risk of death related primarily to anesthesia is estimated to be as low as approximately 1:200,000 anesthetics in large populations.

3. Such a very low anesthesia-attributable mortality rate reflects improvement of perhaps two orders of magnitude over more than 50 years.

4. Despite the very low anesthesia-attributable mortality rate, the very large and increasing number of anesthetics engenders a substantial burden of mortality and morbidity, much of which may be preventable.

5. Approximately 75% of risk actually relates directly to patient-specific characteristics, including age, gender, and comorbidity; 20% to surgical issues, such as experience and judgment; and the remaining 5% to anesthesia factors, including experience, board certification, pharmacologic issues, and overall management of care.

6. The overall anesthesia-attributable mortality rate is now so low that demonstrating further improvement is no longer logistically feasible. However, there are opportunities for meaningful advances in selected subpopulations of high-risk patients or high-risk procedures.

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