PREOPERATIVE HEMORRHAGIC SHOCK AND INTRAOPERATIVE BLEEDING: TWO MAIN CAUSES OF SURGICAL DEATHS IN JAPAN

The Japanese Society of Anesthesiologists (JSA) Subcommittee on Surveillance of Anesthesiarelated Critical Incidents sent confidential questionnaires to all JSA Certified Training Hospitals (n=806 on average) every year from 1999 to 2002. Data collected in the identical forms each year were analyzed for incidence of cardiac arrest and other critical events during anesthesia and surgery, and for outcomes within 7 postoperative days. The principal cause of each critical incident selected from a list of 52 items provided on the questionnaires was also analyzed.With an average response rate of 75.0%, a total of 4, 297, 066 cases were documented over 4 years. A total of 2, 860 patients died within 7 postoperative days. The two principal causes of deaths were preoperative hemorrhagic shock and massive hemorrhage during surgery (Fig. 2), representing 32.8% [95% CI at p<0.05: 31.0, 34.6] and 18.0% [15.1, 20.8] of cases, respectively (Fig. 3). The two principal causes of cardiac arrest during surgery and anesthesia were valso preoperative hemorrhagic shock and massive hemorrhage during surgery (Fig. 4). To reduce life-threatening hemorrhagic events in the operating room and mortality and morbidity within 7 postoperative days in Japan, analysis is need of causes of perioperative bleeding; sequences leading to fatality; adequacy of staffing levels in the operating room; as well as the functional state of the blood supply system from a blood bank, through transfusion service of the hospital to the operating room.