In pure numerical terms, anesthesia-associated mortality has risen again. The reasons for this are the disproportionate increase in the numbers of older and multimorbid patients and surgical procedures that would have been unthinkable in the past. This is the result of a selective literature review of André Gottschalk's working group at the Bochum University Hospital in the current issue of Deutsches Ärzteblatt International (Dtsch Arztebl Int 2011; 108: 469-74).
In the 1940s, anesthesia-related mortality was 6.4/10,000. By introducing safety standards such as pulse oximetry and capnometry, the rate was reduced to 0.4/100,000 by the late 1980s. This value still applies for patients without relevant systemic disease. However, mortality has risen in patients with relevant comorbidities (0.69/100,000). Such comorbidities include heart failure, angina pectoris, chronic renal failure, or severe malignant hypertension. Because of improved safety standards such patients can have surgery nowadays--something that would have been unthinkable in the past owing to their multimorbidity. Another factor explaining anesthesia-related mortality is the fact that the proportion of patients who are older than 65 rose in Germany from 28.8% in 2005 to 40.9% in 2009.