Major incidents and complications in otherwise healthy patients undergoing elective procedures: results based on 1.37 million anaesthetic procedures

Br J Anaesth. 2014 Jul;113(1):109-21. doi: 10.1093/bja/aeu094. Epub 2014 May 5.


Background: Improved anaesthesia safety has made severe anaesthesia-related incidents, complications, and deaths rare events, but concern about morbidity and mortality in anaesthesia continues. This study examines possible severe adverse outcomes or death recorded in a large national surveillance system based on a core data set (CDS).

Methods: Cases from 1999 to 2010 were filtered from the CDS database. Cases were defined as elective patients classified as ASA physical status grades I and II (without relevant risk factors) resulting in death or serious complication. Four experts reviewed the cases to determine anaesthetic involvement.

Results: Of 1 374 678 otherwise healthy, ASA I and II patients in the CDS database, 36 met the study inclusion criteria resulting in a death or serious complication rate of 26.2 per million [95% confidence interval (CI), 19.4-34.6] procedures, and for those with possible direct anaesthetic involvement, 7.3 per million cases (95% CI, 3.9-12.3).

Conclusions: This is the first study assessing severe incidents and complications from a national outcome-tracking database. Annual identification and review of cases, perhaps with standardized database queries in the respective departments, might provide more detailed information about the cascades that lead to unfortunate outcomes.

Keywords: complications; computerized anaesthesia; medical records systems; mortality; outcome assessment.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anesthesia / adverse effects*
  • Anesthesia / mortality
  • Anesthesia / statistics & numerical data
  • Databases, Factual
  • Elective Surgical Procedures / adverse effects*
  • Elective Surgical Procedures / mortality
  • Elective Surgical Procedures / statistics & numerical data
  • Female
  • Germany / epidemiology
  • Hospital Mortality
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Population Surveillance / methods
  • Severity of Illness Index