Hospital Dr News

Low mortality rates in consultant-led anaesthesia

Anaesthetists are responsible for the care of more than 3.5 million patients per year, a study shows.

Three quarters of patients undergo general anaesthesia whilst the other quarter have their procedure either awake or sedated. Almost a quarter of procedures are emergencies.

In a given year 1 in 20 of the population will require an anaesthetic.

The study demonstrates that anaesthesia is a consultant-led service with senior doctors present for 87% of all anaesthetics and for three quarters of those administered “out of hours”. In those patients requiring immediate surgery, the study identified areas where delivery of anaesthesia by senior staff could be further improved.

The 15,460 survey returns after general anaesthesia recorded just nine deaths during the time the patient was under the care of the anaesthetist – a mortality rate of 0.06% or 1 in 1700. Most of the patients who died were elderly, infirm and undergoing emergency surgery.

This survey, which is part of the 5th National Audit Project of the Royal College of Anaesthetists and Association of Anaesthetists of Great Britain and Ireland studying Accidental Awareness during General Anaesthesia, will be published in full on 10 September.

With a 98% return rate and with data from all UK NHS hospitals it captures detailed information on anaesthesia for 20,400 cases, and provides rich information about current anaesthetic processes and techniques.

Dr Mike Sury, consultant anaesthetist at Great Ormond Street and lead author, stated: “The findings contrast interestingly with other studies that have looked at mortality after surgery throughout a hospital stay, such as the European Surgical Outcomes Trial (EuSOS) which reported a 3.6% (1 in 28) mortality. The current survey covers a broader group of patients, but for a shorter period of time, and the mortality is notably lower.”

The study defines current practices in airway management (supraglottic airways predominate), drug selection (highlighting almost universal induction with propofol and the disappearance of halothane), rapid sequence induction (thiopentone used only in a minority of cases and rocuronium increasing in use), muscle relaxation and its reversal (paralysis used in almost half of cases with suggamadex used to reverse less than 2% of cases), use of nitrous oxide (used in more than a quarter of all general anaesthetics).

Professor Jaideep Pandit, consultant anaesthetist in Oxford and Project Lead, added: “The high rates of senior doctor presence throughout the week show that anaesthetists are already embracing seven-day working. In addition the results clearly show the extent of service change that will be required for elective seven-day working to become the norm.”

According to RCoA President, Dr J. P. van Besouw and AAGBI President, Dr William Harrop-Griffiths, both organisations see patient safety as their number one priority: “The low mortality figures reflect a huge body of work by the Association, College and their members in developing safety initiatives to support the specialty, including: Safe Anaesthesia Liaison Group, Patient Safety Alerts, Risk leaflets, Standards of Clinical Practice and National Audit Projects. The figure of 3.5 million patients anaesthetised per year reflects the considerable workload undertaken by anaesthetists working within the NHS.”

Read more here.

Read a blog.

Bookmark and Share

Post a Comment

Enter this security code

Submit Comment for Moderation