• J H Schiff, A Welker, B Fohr, A Henn-Beilharz, U Bothner, H Van Aken, A Schleppers, H J Baldering, and W Heinrichs.
• Department of Anaesthesia and Intensive Care, Katharinenkrankenhaus, Klinikum Stuttgart, Stuttgart, Germany James Cook University, Queensland, Australia janschiff@hotmail.com.
• Br J Anaesth. 2014 Jul 1;113(1):109-21.

BackgroundImproved anaesthesia safety has made severe anaesthesia-related incidents, complications, and deaths rare events, but concern about morbidity and mortality in anaesthesia continues. This study examines possible severe adverse outcomes or death recorded in a large national surveillance system based on a core data set (CDS).MethodsCases from 1999 to 2010 were filtered from the CDS database. Cases were defined as elective patients classified as ASA physical status grades I and II (without relevant risk factors) resulting in death or serious complication. Four experts reviewed the cases to determine anaesthetic involvement.ResultsOf 1 374 678 otherwise healthy, ASA I and II patients in the CDS database, 36 met the study inclusion criteria resulting in a death or serious complication rate of 26.2 per million [95% confidence interval (CI), 19.4-34.6] procedures, and for those with possible direct anaesthetic involvement, 7.3 per million cases (95% CI, 3.9-12.3).ConclusionsThis is the first study assessing severe incidents and complications from a national outcome-tracking database. Annual identification and review of cases, perhaps with standardized database queries in the respective departments, might provide more detailed information about the cascades that lead to unfortunate outcomes.© The Author [2014]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

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