CRNA and patient death

Specialties CRNA

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So I have been researching on where I want to end up and CRNA has stuck for about a year. The question I want to ask current CRNAs is what is it like in the OR when a patient crashes and ultimately dies? What about complications of anesthesia that lead to death? I know that a lot of the times the death will fall back on the anesthesia team and I am just wondering how that has affected you as a provider(and I am aware you must carry insurance).

This is something that I know no one wants to experience but I have to be real and know that it happens. Can anyone share thoughts or experiences?

I don't know if this is true. I have Millers "Basic Anesthesia" and it talks about how insurance has dramatically decreased due to advancements and safer practices in anesthesia.

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Anesthesia related deaths occur 1:300,000 anesthetic cases.

False statement.

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Specializes in Anesthesia.
False statement.

Care to back that up with some research?.

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Care to back that up with some research?.

Splitting hairs, but using the rate of "underlying and contributing" cause of death per million population, the number is more than 2 times higher than one in 300000

(using the paper you cited)

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Specializes in Anesthesia.
Splitting hairs, but using the rate of "underlying and contributing" cause of death per million population, the number is more than 2 times higher than one in 300000

(using the paper you cited)

And can you provide any data or are you just going to keep denying something that you seem to know little about..?

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Specializes in Anesthesia.
Complications in Anesthesiology - Google Books
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Using your paper, the rate of anesthetic related mortality is about one per one million population per year. Your authors put it at about 315 to 320 deaths either directly caused or as a contributing factor. The current estimated annual anesthetics given in the US is around 40000000. That's just under 2.5 deaths per 300,000.

Ultimately this is an impossible number to nail down given the number of indefinable variables at play and under reported/non reported deaths directly attributed to anesthesia. The number is low, but it's not 1 in 300,0000.

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Specializes in Anesthesia.
Using your paper, the rate of anesthetic related mortality is about one per one million population per year. Your authors put it at about 315 to 320 deaths either directly caused or as a contributing factor. The current estimated annual anesthetics given in the US is around 40000000. That's just under 2.5 deaths per 300,000.

Ultimately this is an impossible number to nail down given the number of indefinable variables at play and under reported/non reported deaths directly attributed to anesthesia. The number is low, but it's not 1 in 300,0000.

That is one of many papers that had been published. The most often quoted number for anesthesia related mortality deaths, which was done by the IOM in the 1990s, is 1:200000 to 1:300000, and if you take out the extremely old (greater than 85), the extremely sick PS 4/5, and high risk surgery (such as valve transplants) then that number falls to well below 1:300,000.

Again you have no idea what you are talking about and trying to pick a part one article as proof shows your ignorance on research and anesthesia in general.

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That is one of many papers that had been published. The most often quoted number for anesthesia related mortality deaths, which was done by the IOM in the 1990s, is 1:200000 to 1:300000, and if you take out the extremely old (greater than 85), the extremely sick PS 4/5, and high risk surgery (such as valve transplants) then that number falls to well below 1:300,000.

Again you have no idea what you are talking about and trying to pick a part one article as proof shows your ignorance on research and anesthesia in general.

Well, you picked the paper, I didn't.

As to your IOM paper that you're citing, are you referring to "To Err is Human: building a safer health care system" published by the IOM's Committee on Quality of Health Care in America? The one that claimed that anesthesia related deaths fell from 2 in 10,000 to 1 in 200-300k anesthetics per year in just 20 years? Yes, I'm familiar with that paper. I'm also aware that those numbers are thrown around blindly without any knowledge at all of what actually went into coming up with those conclusions.

Did you actually read that paper or are you just repeating what someone has told you? BTW, do you really find it that easy to believe that anesthesia safety has improved to that order of magnitude in such a short period of time?

Coming up with a hard and fast number has been extremely controversial because of the wild disparity of variables involved as you have demonstrated by pointing out that the number changes when you try to control for acuity alone. That is only one small factor in a constellation of factors that confound accurate risk stratification.

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Anesthesia related deaths occur 1:300,000 anesthetic cases, and most of those will be high risk/sick patients to begin with.

So, not to put too fine a point on this, and, seeing as how ignorance of anesthesia literature is really unforgivable, could you give the source for this number? I'm aware that it is cited in the IOM's "to err is human", but I just can't find where they got it. It isn't in the "literature list" the document provides. Help me out?

Also, could you point to where it says that most of these will be high risk patients? I can't find that in the IOM document either.

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Specializes in Anesthesia.
So, not to put too fine a point on this, and, seeing as how ignorance of anesthesia literature is really unforgivable, could you give the source for this number? I'm aware that it is cited in the IOM's "to err is human", but I just can't find where they got it. It isn't in the "literature list" the document provides. Help me out?

Also, could you point to where it says that most of these will be high risk patients? I can't find that in the IOM document either.

I have provided 3 links to support that mortality rate is very low in anesthesia and depending on how it is calculated could be >1:100000 if you rely solely on ICD codes (which is will always be flawed since it could be the surgeons coding, the anesthesia provider, or independent coder with the first two blaming each other and the last one going by whatever surgical/anesthesia notes that are available at the time) to greater 1:200,000 if you rely on more consistent factors used by the ASA to conduct these studies.

The reference for the 1:300,000 was provided in one of my links, if you have a basic understanding of reviewing literature it will be easy to find. The article that you seem to be debating the most clearly states that most anesthesia related deaths will be from patients of extreme age, PS4+, and high risk procedures. These are all discussed in one form or another in the links I already provided. This again should be no problem to find with a basic understanding of how to review scientific literature and understanding in anesthesia, which you seem to want people to believe that you have.

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