simple mortality question

Tenesma · Feb 8, 2004

i never quote any percentages ever - for two reasons: 1) for most cases that you do there are no intra-mortality rates, and therefore you are only freaking out the patient 2) there are no good studies revealing mortality percentiles....

the only numbers we have are number of intra-op deaths in a total population with no breakdown based on type of surgery, urgency of surgery, age of patient, etc... all the numbers are from extrapolations of anesthesia closed claims studies that are very inaccurate and usually underreported anyway.

what i will tell the patient is that there is a risk involved with everything we do - but that they are negligebly small, and that we have the medications and equipment available to deal with almost all hiccups.

jackieliz · Feb 8, 2004

If the pt has alot of anesthesia related questions, i would probably refer them to the anesthesiologist/CRNA for more up to date/accuate info. Anesthesia sees them in preop holding anyway.

Brenna's Dad · Feb 8, 2004

In my extensive experience (lol), most patients do not ask. However, one of the best analogies that I've heard people use (and the one I use myself), is that there is always a very, very small risk for any anesthesia. Similiar to driving your car or flying in a plane. When you drive your car, there's always a chance something will happen, but this doesn't mean you don't drive your car.

Rhon1991 · Feb 8, 2004

Originally posted by jackieliz
If the pt has alot of anesthesia related questions, i would probably refer them to the anesthesiologist/CRNA for more up to date/accuate info. Anesthesia sees them in preop holding anyway.

Thats who Im asking this question- the anesthesia providers.

Rhon1991 · Feb 8, 2004

Originally posted by Brenna's Dad
In my extensive experience (lol), most patients do not ask.

To legally consent someone for general anesthesia dont you have to delineate most serious risks of anesthesia such as stroke, MI and death? I thought Ive heard them say there is 'less than 1% or 1 in________' that have life threatening adverse reaction to anesthesia... and then the quote you mentioned in reference to driving in your car or flying in airplane?

Tenesma · Feb 8, 2004

for full legal consent you need to make them aware of the risk of MI/stroke/etc... but if you quote some statistic and you go to court then what are you referencing??? where did those percentages come from? stay away from numbers....

it happens to me all the time in the ICU when a family asks what is the percent chance that their loved one will make it or not... i never ever give a percentage... because there is no science behind it

Rhon1991 · Feb 8, 2004

Originally posted by Tenesma
for full legal consent you need to make them aware of the risk of MI/stroke/etc... but if you quote some statistic and you go to court then what are you referencing??? where did those percentages come from? stay away from numbers....

it happens to me all the time in the ICU when a family asks what is the percent chance that their loved one will make it or not... i never ever give a percentage... because there is no science behind it

Ok. I thought there were some statistics out there being quoted. Thanks for clearing that up.

deepz · Feb 9, 2004

Originally posted by Rhon1991
Ok. I thought there were some statistics out there being quoted. ....

Here's a statistic from the IOM ( 1. Institute of Medicine. To Err Is Human: Building a Safer Health System. Washington, DC: National Academy Press; 1999:27.)

"Success in reducing anesthesia-related mortality has been exemplary, with current estimates of death rates as low as 1 death per 200,000 to 300,000 cases."

For more, look here:

http://www.aana.com/press/2003/041103_pine.asp

deepz

Tenesma · Feb 9, 2004

while that is the rough estimate for all-comers - what is the percentage risk of anesthesia related mortality in a 26 year old with diabetes for an elective knee arthroscopy??? there are no numbers - just guesses.... but thank god they are very low

Rhon1991 · Feb 9, 2004

Thanks Deepz! Thats just what I was looking for.

Tenesma, I still understand what you are saying.

smiling_ru · Feb 9, 2004

The IOM report (To Err Is Human) is frequently referenced for anesthesia mortality. But the study that the IOM quoted was small and covered only one hospital.

(Cohen, Marsha M.; Duncan, Peter G.; Pope, William D. B., et al. A Survey of 112,000 Anaesthetics at One Teaching Hospital (1975-1983). Can Anaesth Soc J. 33:22-31, 1986.)

So while these numbers may be accurate for that particular hospital, those particular patients, and that particular area of the world. You can not then tell a patient that their risk of mortality is 1 in 200,000 to 300,000. Because, it simply is not true.

The battles between providers are fought, with everyone trying to say that outcomes/mortality is better with this provider or that provider. The sad thing is we will spend millions performing studies to show better outcomes for one or the other provider, when a much more appropriate study would be a large scale study anestheisa morbidity/mortality.