Editorial Views  |   August 2017
Measuring Perioperative Mortality: The Key to Improvement
Author Notes
  • From the Great Ormond Street Hospital National Health Service Foundation Trust, University College London Great Ormond Street Institute of Child Health, London, United Kingdom (I.A.W.); and Lifebox Foundation, London, United Kingdom (I.H.W.).
  • Corresponding article on page 250.
    Corresponding article on page 250.×
  • Accepted for publication February 27, 2017.
    Accepted for publication February 27, 2017.×
  • Address correspondence to Dr. Walker: isabeau.walker@gosh.nhs.uk
Article Information
Editorial Views / Airway Management / Critical Care / Infectious Disease / Neurosurgical Anesthesia / Obstetric Anesthesia / Patient Safety / Respiratory System / Technology / Equipment / Monitoring / Quality Improvement
Editorial Views   |   August 2017
Measuring Perioperative Mortality: The Key to Improvement
Anesthesiology 8 2017, Vol.127, 215-216. doi:10.1097/ALN.0000000000001714
Anesthesiology 8 2017, Vol.127, 215-216. doi:10.1097/ALN.0000000000001714
JOHN Snow was one of the founding fathers of anesthesia in the late nineteenth century and a pioneering epidemiologist. He recorded the details of more than 5,000 anesthetics during more than 12 yr of practice and stressed the importance of accurate drug administration and patient monitoring.1  In 1949, Mackintosh2  published an analysis of anesthetic deaths and discussed common lessons learned, such as safe positioning of unconscious patients, the appropriate use of thiopentone, and the dangers of cylinder misconnections. He encouraged the investigation of perioperative deaths as a means to improve anesthesia safety. In the modern era, Lunn and Devlin3  worked together as anesthesiologist and surgeon to examine the whole patient journey, recognizing that factors in anesthesia, surgery, and perioperative care required consideration if improvements in outcomes were to be made. Eichorn4  gathered data that supported mandatory standards for anesthetic monitoring, the basis of the American Society of Anesthesiologists standards and guidelines today.5  A recent meta-analysis and systematic review of perioperative mortality and anesthesia-related deaths shows the positive impact of safety interventions over the past 80 yr.6  However, this article also suggests that improvements have not been matched in poorer parts of the world. Indeed, in countries with a low human development index (defined by life expectancy, education, and per capita income indicators), anesthesia mortality has remained unchanged since the 1950s.7  It is particularly refreshing therefore to read the work of Sileshi et al.8  in this edition of Anesthesiology and their demonstration that it is possible to gather high-quality outcome data to improve anesthesia services in a middle-income country.
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