Perioperative mortality and morbidity in Japan for the year 1999 were studied retrospectively. Committee on Operating Room Safety of the Japan Society of Anesthesiologists (JSA) sent confidential questionnaires to 774 Certified Training Hospitals of JSA and received answers from 60.2% of the hospitals. We analyzed their answers with special reference to ASA physical status (
ASA-PS). The total number of
anesthetics analyzed was 655, 644. Mortality and morbidity due to all kinds of causes including
anesthetic management, intraoperative events, co-existing diseases, and operation were as follows. The incidence of
cardiac arrest (per 10,000
anesthetics) was 0.68, 3.76, 14.37, 67.03, 0.36, 4.68, 27.96, 206.30 in patients with
ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The incidences of critical events including
cardiac arrest, severe
hypotension, and severe
hypoxemia were 8.93, 26.99, 71.30, 188.52, 8.68, 31.27, 136.16, and 790.92 in patients with
ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The mortality rates (death during
anesthesia and within 7th postoperative day) after
cardiac arrest were 0.16, 0.94, 5.71, 33.51, 0.00, 1.46, 16.41 and 167.76 per 10,000
anesthetics in patients with
ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The overall mortality rates were 0.24, 1.66, 12.16, 67.03, 0.00, 3.51, 34.65 and 417.14 in patients with
ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. Overall mortality and morbidity were higher in emergency
anesthetics than in elective
anesthetics.
ASA-PS correlated well with overall mortality and with morbidity, regardless of etiology. The incidences of
cardiac arrest totally attributable to
anesthesia were 0.24, 0.45, 1.47, 8.38, 0.36, 1.75, 2.43 and 11.34 in patients with
ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The incidences of all critical events totally attributable to
anesthesia were 4.92, 8.81, 14.74, 20.95, 4.34, 11.40, 15.80 and 22.67 in patients with
ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The mortality rates after
cardiac arrest totally attributable to
anesthesia were 0.00, 0.00, 0.61 and 4.53 in patients with
ASA-PS of I-IV, I E-II E, III E, and IV E, respectively. The overall mortality rates totally attributable to
anesthesia were 0.00, 0.04, 0.18, 0.00, 0.00, 0.61 and 4.53 in patients classified to
ASA-PS of I, II, III, IV, I E-II E, III E, and IV E, respectively. Only one death, due to overdose of
anesthetics, was reported among patients with good physical status (
ASA-PS of I, II, II E and II E).
Anesthetic management was mainly responsible for critical events in patients with good physical status, while co-existing diseases were in those with poor physical status. The major co-existing diseases or conditions leading to critical events were
heart diseases in elective
anesthetics, and
hemorrhagic shock in emergency
anesthetics. We reconfirmed that
ASA-PS is beneficial to predict perioperative mortality and morbidity. It also seems likely that we should make much more efforts to reduce
anesthetic morbidity in patients with good physical status, and to improve preanesthetic assessment and preparation of cardiovascular conditions in those with poor physical status.