New research presented at this year’s World Congress of Anaesthesiologists (WCA) in Hong Kong (28 Aug-2 Sept) shows wide differences in mortality across developing countries, with some countries showing rates around 750 times higher than others. Failed airway management and poor management of bleeding were the main causes of death. The study is by Dr Lionel Dumont, Geneva University Hospital, Geneva, Switzerland.
A recent systematic review and meta-analysis (Lancet, 2012) showed that anaesthesia-related mortality in developing countries is around 5 deaths per 10000 procedures, which is much higher than in Europe (0.1/10000)*. “Based on our experience, we may assume that this mortality rate might be largely underestimated especially in several African countries with limited anaesthetic resources,” explains Dr Dumont. “The aim of this work was to perform a systematic review reporting anaesthesia-related mortality in the developing countries and to identify its main causes.”
Dumont and colleagues performed a systematic search on Medline and the Cochrane Library up to October 2015 for any studies reporting anaesthesia-related mortality or perioperative surgical and obstetrical mortality. Additionally, articles from non-indexed literature as well as the publications from national congresses of anaesthesia, obstetrics and surgery were retrieved by manual search. These were included if valuable data concerning anaesthesia-related mortality was found.
The researchers found that, in developing countries, anaesthesia-related mortality published in the literature varies widely ‒ from 0.5/10000 in Pakistan up to around 370/10000 in Togo and the Democratic Republic of Congo. Failed airway management and inadequate blood management during serious bleeding are the main causes of anaesthesia-related deaths in developing countries.
Dr Dumont says: “We found much higher rates of anaesthesia-related mortality in most developing countries compared to the recent systematic review and meta-analysis. This is probably due to our much larger and less specific search of the literature. Non-indexed publications and non-anaesthesia literature should be taken into count when studying outcomes in developing countries. Improved education and establishment of clear policies in emergency situations can decrease these high rates of mortality related to anaesthesia.”
