Survey of 11-year Anesthesia-related Mortality and Analysis of its Associated Factors in Taiwan

Received 12 April 2010; received in revised form 10 May 2010; accepted 13 May 2010.

Objective

In developed countries, the societies of anesthesiologists have published reports of anesthesia quality. However, there are still no publications on anesthesia quality in Taiwan, even though the Taiwan Society of Anesthesiologists (TSA) was founded in 1956. This study was designed to evaluate the quality of anesthesia in Taiwan using databases maintained by the TSA and the Bureau of National Health Insurance-Taiwan (BNHI-T).

Methods

The TSA published annual reports in 1995–1998 and 2002–2008 (with a 3-year interval), which included a survey on anesthesia-related mortality and morbidity, the manpower and composition of anesthesia teams, and the causes of anesthesia-related complications. Since 2002, the BNHI-T has collaborated with the National Health Research Institute-Taiwan to establish a database of health care service. To understand anesthesia quality in Taiwan, we collected data from the annual TSA surveys and the BNHI-T, and analyzed trends in anesthesia-related mortality, causes of anesthesia complications, and relative manpower composition.

Results

The rate of anesthesia-related mortality was 11.9 deaths/100,000 cases. More than 50% of all anesthesia-related complications were preventable. About 1500 anesthetic procedures were performed annually by each anesthesiologist in Taiwan. The ratio of anesthesiologists to nurse anesthetists was 1:3–5.

Conclusion

Anesthesia-related mortality was about 10-fold higher in Taiwan than in the United States, Japan and the United Kingdom. Mortality related to quality of anesthesia in Taiwan must be reduced. To achieve this target, we have recommended the following six approaches: (1) decrease the workload of anesthesiologists; (2) increase reimbursement by the BNHI-T for anesthesia; (3) improve the training quality of anesthetist residents; (4) strengthen the quality of board examinations; (5) improve the training quality of nurse anesthetists; and (6) standardize monitoring procedures and equipment. Only once these measures are introduced, in combination with effective quality assurance and subjective improvement systems, can we expect an improvement in the quality of anesthesia in Taiwan.

Key Words: anesthesia-related mortality , Taiwan

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Article Outline

• Abstract

• References

• Copyright

References

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a Department of Anesthesiology, Tri-Service General Hospital/National Defense Medical Center, Taipei, Taiwan, R.O.C.

b Graduate Institute of Life Science, National Defense Medical Center, Taipei, Taiwan, R.O.C.

c Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, R.O.C.

d Division of Anesthesiology, Cheng-Hsin General Hospital, Taipei, Taiwan, R.O.C.

e Department of Anesthesiology, Chi-Mei Medical Center, Tainan, Taiwan, R.O.C.

f Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan, R.O.C.

g Department of Anesthesiology, National Cheng-Kung University Hospital, Tainan, Taiwan, R.O.C.

Corresponding author. Department of Anesthesiology, Tri-Service General Hospital/National Defense Medical Center, Taipei, Taiwan, R.O.C.

PII: S1875-4597(10)60014-8

doi:10.1016/S1875-4597(10)60014-8

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