Perioperative Mortality in Outpatient Surgery

Warner and colleagues^[181] at the Mayo Clinic studied major morbidity and mortality occurring within 1 month after ambulatory surgery in 38,598 patients (see Chapter 68 ). Four patients died, two of myocardial infarction and two in an automobile accident ( Fig. 24-3 ). The two deaths from myocardial infarction occurred at least 1 week after surgery and were not directly attributable to anesthesia. Considering the rate of mortality directly related to anesthesia described in the CEPOD study, no deaths would be expected in a study of this size.

Fleisher and colleagues^[68] performed a claims analysis of patients undergoing 16 different surgical procedures in a nationally representative (5%) sample of Medicare beneficiaries for the years 1994 through 1999. A total of 564,267 procedures were studied, with 360,780 in an outpatient hospital, 175,288 in an ambulatory surgery center (ASC), and 28,199 in an office. On the day of surgery, no deaths occurred in the office, but 4 occurred in the ASC (2.3 per 100,000), and 9 occurred in the outpatient

Figure 24-2 Relationship between the American Society of Anesthesiologists (ASA) physical status classification and perioperative mortality (within 2 days of surgery) related to anesthesia provided in urban and suburban institutions. (Adapted from Lagasse RS: Anesthesia safety: Model or myth? A review of the published literature and analysis of current original data. Anesthesiology 97:1609, 2002.)

903

Figure 24-3 Timing of perioperative events in patients undergoing ambulatory surgery. Many of the events occur within the first 48 hours and probably are related to the stress of surgery. A subset of events occurring after this period may be related to background event rates. The overall rate of morbidity was lower than expected for a similar cohort of age-matched nonsurgical patients. (From Warner MA, Shields SE, Chute CG: Major morbidity and mortality within 1 month of ambulatory surgery and anesthesia. JAMA 270:1437, 1993.)