Deep down, every surgical patient has the same worry:  How safe is anesthesia and surgery? Methods of evaluating anesthetic mortality are inexact and controversial.


In 1999 the Institute of Medicine published their report entitled To Err is Human: Building a Safer Health Care System.  In this report, the Committee on Quality of Health Care in America stated that, “anesthesia is an area in which very impressive improvements in safety have been made.”  The Committee cited anesthesia mortality rates that decreased from 1 death per 5,000 anesthetics administered during the 1980s, to 1 death per 200,000-300,000 anesthetics administered in 1999.  These statistics reflected the frequency of all patients, healthy or ill, who died in the operating room.

However, this conclusion that anesthesia mortality has plummeted is not universal.  When mortality is defined as any patient who dies within 48 hours following surgery, the statistics are much different.  In 2002, anesthesiologist Dr. Robert S. Lagasse of the Albert Einstein College of Medicine in New York published a study in Anesthesiology, the specialty’s leading journal, which challenged the Institute of Medicine report.

Lagasse presented data on surgical mortality from two academic New York hospitals between the years 1992 and 1999.  When mortality was defined as anydeath occurring within 48 hours following surgery, there were 351 deaths in 184,472 surgeries–an overall surgical mortality rate of 1 death per 532 cases.

Deaths related to anesthesia errors were much less–only 14 deaths out of 184,472 surgeries–a rate of 1 death per 13,176 cases.   However, Lagasse’s anesthesia-related mortality rate of 1 per 13,176 surgeries was significantly different that the Institute of Medicine’s rate of 1 death per 200,000-300,000 surgeries.  Lagasse wrote, “We must dispel the myth that anesthesia-related mortality has improved by an order of magnitude. Science does not support this claim.”

Lagasse compared anesthesia to the aviation industry: “The safety of airline travel, for example, has increased dramatically in this century, but since the 1960s there has been minimal improvement in fatality rates.  This may be due to the effect that improved safety technology has had on air traffic density.  Technology has made it possible to meet production pressures of the commercial airline industry by allowing more takeoffs and landings with less separation between aircraft.  With this increased aircraft density comes increased danger, thereby offsetting potential improvements in safety.  This may be analogous to the practice of anesthesiology in which improvements in medical technology have led to increased anesthetic management of older patients with significantly more concurrent disease.”

Today’s surgery patients are sicker than ever.  Five percent of all surgical patients die within one year of surgery.  For patients over the age of 65 years, 10% of all surgical patients die within one year of surgery. The authors of this data wrote, “Death during the first year after surgery is primarily associated with the natural history of preexisting conditions. However, cumulative deep hypnotic time and intraoperative hypotension were also significant, independent predictors of increased mortality. These associations suggest that intraoperative anesthetic management may affect outcomes over longer time periods than previously appreciated.”

In a recent update, Dr. Jeana Havidich, an associate professor of anesthesiology at Dartmouth-Hitchcock Medical Center in New Hampshire, presented the following preliminary data at the October 2014 American Society of Anesthesiologist convention:

  1. From more than 3.2 million cases of anesthesia use between 2010 and 2013, the rate of complications decreased from 11.8 percent to 4.8 percent. The most common minor complication was nausea and vomiting (nearly 36 percent) and the most common major complication was medication error (nearly 12 percent).
  2. The death rate remained at three deaths per 10,000 surgeries/procedures involving anesthesia.
  3. Among the other findings: complication rates were not higher among patients who had evening or holiday procedures; patients older than 50 had the highest rates of serious complications; and healthier patients having elective daytime surgery had the highest rates of minor complications.

Data published in 2015, in a study of mortality in surgical cases from 2010 to 2014 (Whitlock EL, Feiner, JR, Chen LI, Perioperative Mortality, 2010 to 2014 A Retrospective Cohort Study Using the National Anesthesia Clinical Outcomes Registry. Anesthesiology, V 123, No 6, Dec 2015, 1312-1321) showed the following:

  1. The authors analyzed 2,866,141 cases and 944 deaths (crude mortality rate, 33 per 100,000)
  2. Independent risk factors for higher mortality were: emergency case status, surgical cases beginning between 4 p.m. and 6:59 a.m., patient age less than one year or greater than or equal to 65 years, and sicker patients with an increased American Society of Anesthesiologists physical status score.

Anesthesia is safer than it has ever been, but risk factors such as emergencies, very young or old patients, or sicker patients, do increase the risk. The new finding in this 2015 publication was that surgeries which began late in the day or night (after 4 p.m. until 6:59 a.m.) had increased mortality.


The most popular posts for laypeople on The Anesthesia Consultant include:

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The most popular posts for anesthesia professionals on The Anesthesia Consultant  include:

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  1. A man age 70 was in car accident and died at the scene after being treated by medics. The patients. Toxicology report shows the man had 1421 ng/ml of Rocuronium (Zemuron) in his system. Is this a common dose amount ?

    1. This is a curious question. The toxicology report should show zero rocuronium in someone riding in a car. We do not routinely measure rocuronium blood concentrations. The only time trace rocuronium would be present in the blood would be if the man had just been released from a surgery center after an uncomplicated anesthetic. Was this the case? The man would not be driving a car after an anesthetic. He would have to be a passenger. The rocuronium concentrations in a passenger would be an incidental finding unrelated to the accident or to his death.

  2. Hello.

    I am 36yo, 175cm high, 103kg weight, one year and half i dont smoke, i am drinking alcohol 5-10 times a year. I am taking Nexium 20mg/day.

    I will have surgery of the soft palate as i am snoring badly.

    How safe is anesthesia for me? In % what is possibility that i will not wake?

    Thank you for your answer.


    1. You will almost certainly wake up!
      I’ll infer from your question that you have obstructive sleep apnea. Your BMI is 33, which means you are obese.
      You will have significant pain postoperatively, which is universal after this surgery. You will receive pain relievers IV to reduce the pain.
      You will be observed overnight in a hospital after surgery, because of all the above reasons.
      Yours is a common surgery. There are risks of bleeding or breathing problems, but in competent hands you can expect to do well.
      Good luck.

  3. Hi I am having hernia surgery and have had passed episodes of svt nonsestanable , aswell as pvcs and pacs longer period of time. my cardiologist says my heart is healthy I am 25 years old And never had any problems till after my wisdom teeth we’re removed last year. After that problems accurred with my heart . Could anesthesia be the cause of this .

    1. It’s impossible to give you an informed opinion, because I’m not your doctor, but I don’t think the anesthesia for wisdom teeth surgery caused your heart rhythm problems. During wisdom teeth surgery, the oral surgeon injects local anesthesia which contains adrenaline (epinephrine), and this can cause immediate and temporary heart rhythm problems. Most likely it had no lasting effect. If your cardiologist says your heart is healthy, that’s very important and excellent news.

  4. my baby who is 18 months she is having tubes in her ears and an abr test. what is the statistics of death due to anesthesia for her age?

    1. The complications rate for this should be close to zero.

      The ear tubes is a minor procedure, and the abr is not a surgery, but requires a period of an hour or so of general anesthesia. The infant will usually have a mask induction with sevoflurane, after which an IV is placed.

      I usually do this anesthetic with propofol and a laryngeal mask airway tube. In competent hands your infant will be safe.

  5. I broke my leg in may playing soccer was at the end of a bad challenge from a dirty player anyways I had the bottom tibial screws removed in august however I have one left at the top of my tibia and the rods probably in there for life. i am thinking of removing the screw I’m just scared to go under again was thinking of just getting local and stay awake thru it would love your opinion.

    1. Roger,

      Of course I know nothing of your age and general medical health, but the anesthetic for a screw removal should be brief.

      I always choose the simplest anesthetic that works for all three parties: the surgeon, the patient, and the anesthesiologist. If the screw can be removed under local anesthesia, or local plus intravenous sedation, that would be great. If the surgeon and anesthesiologist who are caring for you advise general anesthesia, they will probably have a sound medical reason for that recommendation.

  6. Hi! I’m a mother of three and before my 3rd child I had a tummy tuck and breast augmentation. That was 10 years ago, my tummy tuck was destroyed due to my last pregnancy plus the previous surgeon left me with a horrible looking scarred belly button and my scar is too high. My breast implants are now smaller since the water has been evaporating. My youngest is now 2 and husband recently got a vasectomy. I’m 32 years old and want that pretty looking belly and fuller breasts. I went to see a new plastic surgeon and he advised me I would need another tummy tuck and lipo for the flanks plus if I liked I could increase the size of my breasts. I’m healthy, 5’1 120 lbs. my husband is worried I won’t wake up, my surgery will be performed at a hospital. What are my chances of not waking up? it’s scary to think about, I just want to feel comfortable in my skin and feel pretty in a bikini.

    1. The chance of a serious complication for your anesthesia is close to zero. You are young and healthy, and the surgery is one prone to medical complications. Anesthesia for you for this procedure is approximately as safe as you taking a commercial airline trip in the United States. You wouldn’t fear taking an airplane from Chicago to San Francisco, nor should you fear this anesthetic.

  7. I am 32, and considering a breast augmentation & lift.
    5’6, 138lbs, atheletic and healthy.
    I’m a little afraid of anesthesia. My surgery will be done with an IV & local. Does this sound like a safe procedure for me? I have had Iv sedation three other times with no issues, but they were for more minor oral surgeries. My potential surgeon informed me that the sedation I’d receive for this procedure is more of a deep sleep.
    I have two little ones and don’t want to do anything that could be risky.
    Your opinion is greatly appreciated! 🙂

    1. Let me ease your worries.
      You are young and healthy, and your anesthesia risks are close to zero, statistically about as safe as taking a commercial airline flight.

      Dr. Novak

  8. I am having knee surgery to repair an all and remove meniscus portions. I am 38 fairly healthy. I do have very high cholesterol and do drink everyday. I am not heavy in weight. Stand 5’6 and weigh 162. I believe they are performing arthroscopic surgery but unsure of what type of anesthesia I should have and want to be safe. Please would like to hear your ideas

    1. Yours is a common and safe procedure, with minimal surgery and anesthesia risks. You are healthy and young. Most anesthesiologists will choose a general anesthetic, with propofol and sevoflurane as the main drugs used. Other options such as am epidural, a spinal, or local anesthesia are less attractive. Trust your anesthesiologist, and you’ll do great.

  9. Hello Doctor,
    So my question is i have had 3 procedures previously that have required anesthesia .
    1. Labiaplasty 2.Had a mass removed behind my ear( just fatty tissue) 3. Colonoscopy( IBS-C) . Yet again, i need to put under a fourth time ;I have a molar and wisdom teeth under my gums causing me swelling and soreness. I am currently 25 and concerned that this is way to many times… Can this lead to complications since i have had it done to many times. Also, i have another question …Once i get older will my risk of complications increase if i need to get administer for anesthesia for a 5th time. I would appreciate your response doctor !!!

    1. I’ll assume your general health (heart, lungs, weight, blood pressure are normal. At your age, there is no data that multiple general anesthetics will affect you in any negative way. Many people have multiple safe anesthetics as they age. You can be reassured, your risk of complications is no greater than the general population.

  10. My close relative is 85 years old. She had one episode of GERD/heartburn recently, and her doctor wants an endoscopy. She had one in 2012, which was negative . Her gastroenterologist will not discuss the anesthesia risks. I am beyond shocked. My G.I. doc does not do endoscopy on patients in their 80’s, with the exception of a bleed. Please tell me if their is a risk of anesthesia and complications wifh propofol, that has no reversal agent. Especially, at her advanced age. Thank you.

    1. It depends on how healthy the 85-year-old patient is. There are risks to sedation for an upper GI endoscopy, but the risks are less than that of general anesthesia for a surgical procedure.

      The patient should have a preoperative assessment of her health by her primary care doctor, and then the gastroenterologist should give an informed consent regarding the risks vs. benefits of having the endoscopy done.

      We do see endoscopy sedation given to 85-year-olds for upper GI endoscopy. This sedation may be conscious sedation with fentanyl plus midazolam, or more rarely, the sedation/anesthetic may be propofol. If propofol is used, an anesthesiologist or nurse anesthetist must be employed to safely administer the propofol.

  11. Before I was born my father had a severe reaction to succinylcholine. I now work as an EMT and am around paramedics who use succ regularly. When I was young, they did not want to test me because his reaction caused severe reactions like lockjaw and cardiac arrest. I am now 18, are there any tests that can be performed to determine if I am also allergic to succ?

    1. From your description, it sounds like your father may have either had masseter spasm or a hyperkalemia cardiac arrest from succ.

      Masseter spasm is related to Malignant Hyperthermia. To find out if you are an MH susceptible individual, you’d need to have a muscle biopsy done under local anesthesia. Tests are done on the muscle to determine if you are MH susceptible.

      Hyperkalemic cardiac arrest can occur in healthy-appearing individuals who have been given succ if that individual has an undiagnosed muscular dystrophy. I’m no expert on muscular dystrophies, but their diagnosis is usually also made via muscle biopsy under local anesthesia. It’s possible to do screening DNA testing or screening blood CPK testing.

      If you choose not to have any of the above workups, my advice to you is simply this: Tell your healthcare providers you may be allergic to succ, as your father had severe reactions, and that you do not want to have any succ given to you. For almost every situation, there is a medical way to handle the airway using safer alternatives to succ, such as using rocuronium. You may consider wearing a Medic-Alert bracelet listing succinylcholine as an adverse reaction.

  12. Hi there. I am about to donate a kidney. 51 yrs old BMI 32 (But I am very muscular) Have had a history of SVT but keep myself pretty fit.

    I could not believe what I read – that 1 in 20 people die within one year of general anesthesia and that rises to10% if over 65…Wow ! Is this really true ?

    1. You are relatively young (51 years old), and yours is an elective surgery. Your mortality would be much lower than 5% over one year.

      For all surgeries, the one year mortality is indeed 5%. See the reference below:

      Anesth Analg. 2005 Jan;100(1):4-10.
      Anesthetic management and one-year mortality after noncardiac surgery.
      Monk TG1, Saini V, Weldon BC, Sigl JC.

      Little is known about the effect of anesthetic management on long-term outcomes. We designed a prospective observational study of adult patients undergoing major noncardiac surgery with general anesthesia to determine if mortality in the first year after surgery is associated with demographic, preoperative clinical, surgical, or intraoperative variables. One-year mortality was 5.5% in all patients (n = 1064) and 10.3% in patients > or =65 yr old (n=243). Multivariate Cox Proportional Hazards modeling identified three variables as significant independent predictors of mortality: patient comorbidity (relative risk, 16.116; P <0.0001), cumulative deep hypnotic time (Bispectral Index <45) (relative risk=1.244/h; P=0.0121) and intraoperative systolic hypotension (relative risk=1.036/min; P=0.0125). Death during the first year after surgery is primarily associated with the natural history of preexisting conditions. However, cumulative deep hypnotic time and intraoperative hypotension were also significant, independent predictors of increased mortality. These associations suggest that intraoperative anesthetic management may affect outcomes over longer time periods than previously appreciated.

  13. My 6 year old is needing to be put to sleep to have 3 teeth pulled do k a abses, we have been fighting with for over a year. She does have asthma and a small heart murmur. Is this a safe surgery for her?

  14. hello
    i am getting anesthesia on Friday and i am really worried i wont wake up!
    I am getting mouth surgery and an having some anxiety please tell me something i need to know or do before this!

    1. Anesthesia risks for healthy patients are very low. The answer to your question depends on many things, such as the actual surgical procedure, your age, weight, and health history, and whether you are having an anesthesia professional attend to you or not. Assuming you are not elderly, not sick, not obese, and that competent doctors are attending to you, your risks will be low.

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