Having assessed the patient preoperatively, it is not surprising that anesthetists try to assess the risks of anesthesia (and surgery). In the United Kingdom, the Confidential Inquiry into Perioperative Deaths (CEPOD, 1987) revealed an overall perioperative mortality of 0.7% in approximately 500 000 operations. Anesthesia was considered to have been a contributing factor in 410 deaths, but judged completely responsible in only 3 cases – a primary mortality rate of 1 : 185 000 operations. When the deaths where anesthesia contributed were analyzed, the predominant factor was human error (Table 1.2). Although problems with equipment are often described, these were shown to be minimal. Table 1.2 Major factors identified as contributing to anesthetic associated deaths.

A wide variety of other factors have been identified as contributing to the risk of mortality in the operative and postoperative period (Table 1.3).

Table 1.3 Factors associated with increased risk of mortality. Of the factors listed in Table 1.3, physical status has proved to be a powerful predictor of postoperative mortality. The commonest method of categorizing patients is by using the American Society of Anesthesiologists (ASA) physical status scale (Table 1.4). The patient’s ASA physical status has been shown to be relate to both absolute and crude postoperative mortality (Table 1.5). Further reductions in the perioperative mortality of patients have been shown to result from improving preoperative preparation by optimizing patient’s physical status, adequately resuscitating those who require emergency surgery, appropriate monitoring intraoperatively and the provision of postoperative care, in a high dependency or intensive care unit if indicated.

Table 1.5 Relationship between American Society of Anesthesiologists (ASA) status and postoperative mortality.

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