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November 18, 1988, Vol 260, No. 19 >
ARTICLE | November 18, 1988

Does Anesthesia Contribute to Operative Mortality? FREE

Marsha M. Cohen, MSc, MD, MHSc, FRCPC; Peter G. Duncan, MD, FRCPC; Robert B. Tate, MSc
[+] Author Affiliations

Reprint requests to Department of Community Health Sciences, University of Manitoba, 750 Bannatyne Ave, Winnipeg, Manitoba, Canada R3E 0W3 (Dr Cohen).


JAMA. 1988;260(19):2859-2863. doi:10.1001/jama.1988.03410190107032
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References

An anesthesia follow-up program (100 000 anesthetics) and vital statistics data were used to assess the role of anesthesia in operative deaths. Four factor groups (patient, surgical, anesthesia, and "other") were assessed by logistic regression analysis to ascertain which variables were predictive of seven-day mortality. Advanced age, male gender, physical status, major surgery, emergency procedure, procedures performed in 1975 to 1979, intraoperative complications, narcotic techniques, and having one or two anesthetic drugs administered were associated with increased mortality, whereas duration of anesthesia, experience of the anesthesiologist, and inhalation techniques were not. Receiver-operator characteristic curves showed no increment in prediction of operative mortality greater than that for patient plus surgical factors when "other" or anesthetic factors were added. Patient and surgical risk factors were much more important in predicting seven-day mortality than the anesthesia factors we studied.

(JAMA 1988;260:2859-2863)

REFERENCES

1 +
Flood AB, Scott WR, Ewy W:  Does practice make perfect? Part II. The relation between volume and outcomes and other hospital characteristics . Med Care 1984;;22:115-125.
2 +
Riley G, Lubitz J:  Outcomes of surgery among the Medicare aged: Surgical volume and mortality . Health Care Finance Rev 1986;;7:37-47.
3 +
Maerki SC, Luft HS, Hunt SS:  Selecting categories of patients for regionalization: Implications of the relationship between volume and outcome . Med Care 1986;;24:148-158.
4 +
Luft HS:  The relation between surgical volume and mortality: An exploration of causal factors and alternative models . Med Care 1980;;18:940-959.
5 +
Lubitz J, Riley G, Newton M:  Outcomes of surgery among the Medicare aged: Mortality after surgery . Health Care Finance Rev 1985;;6:103-115.
6 +
Ziffren SE:  Comparison of mortality rates for various surgical operations according to age groups, 1951-1977 . J Am Geriatr Soc 1979;;27:433-438.
7 +
Harrison GG:  Deaths attributable to anaesthesia: A ten year survey (1967-1976) . Br J Anaesth 1978;;50:1041-1046.
8 +
Turnbull KW, Fancourt-Smith PF, Banting GC:  Death within 48 hours of anaesthesia at the Vancouver General Hospital . Can J Anaesth 1980;;27:159-162.
9 +
Farrow SC, Fowkes FGR, Lunn JN, et al:  Epidemiology in anaesthesia: II. Factors affecting mortality in hospital . Br J Anaesth 1983;;54:811-816.
10 +
Saklad M:  Grading of patients for surgical procedures . Anesthesiology 1941;;2:281-285.
11 +
Burnham M, Craig DB:  A post-anaesthetic follow-up program . Can J Anaesth 1980;;27:164-168.
12 +
Cohen MM, Duncan DG, Pope WDB, et al:  A survey of 112 000 anaesthetics at one teaching hospital (1975-1983) . Can J Anaesth 1987;;33:22-31.
13 +
Walker SH, Duncan DB:  Estimation of the probability of an event as a function of several independent variables . Biometrika 1967;;54:167-179.
14 +
Hanley JA, McNeil BJ:  The meaning and use of the area under an ROC curve . Radiology 1982;;143:29-36.
15 +
Vacanti CJ, VanHouten RJ, Hill RC:  A statistical analysis of the relationship of physical status to postoperative mortality in 68 388 cases . Anesth Analg 1970;;49:564-566.
16 +
Bunker JP, Child CG, Davidson CS, et al:  Summary of the National Halothane Study: Possible association between halothane anesthesia and post° operative hepatic necrosis . JAMA 1966;;197:121-134.
17 +
Charlson ME, Sax FL, MacKenzie R, et al:  Assessing illness severity: Does clinical judgement work? J Chronic Dis 1986;;39:439-452.
18 +
Cohen MM, Duncan PG:  Physical status score and trends in anesthetic complications . J Clin Epidemiol 1988;;41:83-90.
19 +
Wennberg JE, Roos N, Sola L, et al:  Use of claims data systems to evaluate health care outcomes: Mortality and reoperation following prostatectomy . JAMA 1987;;257:933-936.
20 +
Utting JE, Gray TC, Shelley FC:  Human misadventure in anaesthesia . Can J Anaesth 1979;;26:472-478.
21 +
Davies JM, Strunin L:  Anesthesia in 1984: How safe is it? Can Med Assoc J 1984;;131:437-441.
22 +
Derrington MC, Smith G:  A review of studies of anaesthetic risk, morbidity and mortality . Br J Anaesth 1987;;59:815-833.
23 +
Cooper J, Newbower RD, Kitz RJ:  An analysis of major errors and equipment failures in anesthesia management: Considerations for prevention and detection . Anesthesiology 1984;;60:34-62.
24 +
Abbott RD, Carroll RJ:  Interpreting multiple logistic regression coefficients in prospective observational studies . Am J Epidemiol 1984;;119:830-836.
25 +
Hughes EFX, Fuchs VR, Jacoby JE,etbal:  Surgical workloads in a community practice . Surgery 1972;;71:315-327.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Flood AB, Scott WR, Ewy W:  Does practice make perfect? Part II. The relation between volume and outcomes and other hospital characteristics . Med Care 1984;;22:115-125.
2 +
Riley G, Lubitz J:  Outcomes of surgery among the Medicare aged: Surgical volume and mortality . Health Care Finance Rev 1986;;7:37-47.
3 +
Maerki SC, Luft HS, Hunt SS:  Selecting categories of patients for regionalization: Implications of the relationship between volume and outcome . Med Care 1986;;24:148-158.
4 +
Luft HS:  The relation between surgical volume and mortality: An exploration of causal factors and alternative models . Med Care 1980;;18:940-959.
5 +
Lubitz J, Riley G, Newton M:  Outcomes of surgery among the Medicare aged: Mortality after surgery . Health Care Finance Rev 1985;;6:103-115.
6 +
Ziffren SE:  Comparison of mortality rates for various surgical operations according to age groups, 1951-1977 . J Am Geriatr Soc 1979;;27:433-438.
7 +
Harrison GG:  Deaths attributable to anaesthesia: A ten year survey (1967-1976) . Br J Anaesth 1978;;50:1041-1046.
8 +
Turnbull KW, Fancourt-Smith PF, Banting GC:  Death within 48 hours of anaesthesia at the Vancouver General Hospital . Can J Anaesth 1980;;27:159-162.
9 +
Farrow SC, Fowkes FGR, Lunn JN, et al:  Epidemiology in anaesthesia: II. Factors affecting mortality in hospital . Br J Anaesth 1983;;54:811-816.
10 +
Saklad M:  Grading of patients for surgical procedures . Anesthesiology 1941;;2:281-285.
11 +
Burnham M, Craig DB:  A post-anaesthetic follow-up program . Can J Anaesth 1980;;27:164-168.
12 +
Cohen MM, Duncan DG, Pope WDB, et al:  A survey of 112 000 anaesthetics at one teaching hospital (1975-1983) . Can J Anaesth 1987;;33:22-31.
13 +
Walker SH, Duncan DB:  Estimation of the probability of an event as a function of several independent variables . Biometrika 1967;;54:167-179.
14 +
Hanley JA, McNeil BJ:  The meaning and use of the area under an ROC curve . Radiology 1982;;143:29-36.
15 +
Vacanti CJ, VanHouten RJ, Hill RC:  A statistical analysis of the relationship of physical status to postoperative mortality in 68 388 cases . Anesth Analg 1970;;49:564-566.
16 +
Bunker JP, Child CG, Davidson CS, et al:  Summary of the National Halothane Study: Possible association between halothane anesthesia and post° operative hepatic necrosis . JAMA 1966;;197:121-134.
17 +
Charlson ME, Sax FL, MacKenzie R, et al:  Assessing illness severity: Does clinical judgement work? J Chronic Dis 1986;;39:439-452.
18 +
Cohen MM, Duncan PG:  Physical status score and trends in anesthetic complications . J Clin Epidemiol 1988;;41:83-90.
19 +
Wennberg JE, Roos N, Sola L, et al:  Use of claims data systems to evaluate health care outcomes: Mortality and reoperation following prostatectomy . JAMA 1987;;257:933-936.
20 +
Utting JE, Gray TC, Shelley FC:  Human misadventure in anaesthesia . Can J Anaesth 1979;;26:472-478.
21 +
Davies JM, Strunin L:  Anesthesia in 1984: How safe is it? Can Med Assoc J 1984;;131:437-441.
22 +
Derrington MC, Smith G:  A review of studies of anaesthetic risk, morbidity and mortality . Br J Anaesth 1987;;59:815-833.
23 +
Cooper J, Newbower RD, Kitz RJ:  An analysis of major errors and equipment failures in anesthesia management: Considerations for prevention and detection . Anesthesiology 1984;;60:34-62.
24 +
Abbott RD, Carroll RJ:  Interpreting multiple logistic regression coefficients in prospective observational studies . Am J Epidemiol 1984;;119:830-836.
25 +
Hughes EFX, Fuchs VR, Jacoby JE,etbal:  Surgical workloads in a community practice . Surgery 1972;;71:315-327.

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