Abstract
Keywords
anesthesiaeditorialFar Eastmortalityperioperative;
Florence Nightingale, the social reformer and founder of modern nursing, pioneered the application of medical statistics to improve patient outcomes in hospitals. She took measurements in British field hospitals during the Crimean War and used calculations to determine that more soldiers died from infectious diseases exacerbated by unsanitary conditions than died from battle injuries. Nightingale invented compelling data visualization formats and used them to convince Queen Victoria to order systematic improvements in military and later civilian hospital management standards and practices. Ultimately, Nightingale's work resulted in modernizing hospital policies and procedures that continue to save lives and improve
While opinion on the relative value of surgery has remained controversial from its inception, a developing consensus tenders it as impacting vitally and positively on global public health.3 Experts are asserting that operative interventions are a boon as a factor influencing disability-adjusted life years and in terms of more fundamental constructs such as economic and psychological well-being; further, they assert that this value has been underestimated
A recent major review and meta-analysis on anesthetic-related mortality and anesthetic-related cardiac arrest found a significant reduction over time in
Another study found reduced
Only one nationwide investigation of anesthesia-related mortality in Taiwan has been published since the establishment of the National Health Insurance Plan in 1995. It found an average anesthetic-caused mortality rate of 11.9/100,000 cases over the years 1995–1998 and 2002–2008 (sufficient data were not collected in the intervening years), which compares poorly with other developed countries cited in the study.9 Table 1 summarizes that data.
The findings suggest that Taiwan suffers an anesthetic-related mortality rate ten times higher or more than those reported for other developed countries. We pause today to reflect on this information and its implications, to consider how well we can assume that the research, in Taiwan or elsewhere, has been able to capture reality and then we turn our gaze. We look backward in time, from the publication of the Taiwanese study 6 years ago, to the present day, and onward into the future, and we look outward, to other countries in East Asia: China (including Hong Kong), Mongolia, Japan, North Korea, and South Korea; to other neighbors in Southeast Asia and the Asian Pacific region. Finally, we anticipate whether and how we might liaise between Taiwan and other countries in East Asia, where we may enjoy cultural and language connections and possess relevant knowledge about clinical and bureaucratic practices, and researchers elsewhere who specialize in international assessment of anesthetic and surgical risk and safety.
We know that an additional dataset exists for nationwide anesthetic-related mortality in Taiwan for the years subsequent to those analyzed by Liu et al,9
Obtaining clear, valid, and useful data on the safety of anesthesia is a challenge. An entry point for the introduction of
A cautionary story recently appeared in the form of a study published in the BMJ which stirred international headlines: The authors noted that death certificate reporting procedures in the United States obscured medical error as a cause of death. Using more careful methods, they estimated that deaths caused by medical error were more than 2.5 times greater than most currently-cited figures. The corrected estimate lists medical error as the third leading cause of death in the US after heart disease and cancer.10
A 2002 review of the literature on anesthesia safety sharply called into question the validity of contemporary studies on the issue, pointing to concerns with operational definitions, and concluded that “wide variations based on methodological differences reported in the literature make it impossible to detect trends in anesthesia safety”.11 Such problems continue to be cited in more recent studies and reviews, with one major 2009 review describing findings on anesthetic safety trends as “controversial”.12
Researchers treating anesthetic-related safety, risk, and mortality should carefully lay the appropriate groundwork before undertaking projects in this area. It appears sensible to believe that anesthesiology has come a long way and is safer today in more areas of the world than in past decades, while being administered to a population that is increasingly older and presents with more complex and fragile clinical situations. However, we pay heed to the warnings sounded by experts in
Florence Nightingale lives on in the popular imagination, particularly in the West, symbolized as “the lady with the lamp” (Figure 1) making hospital rounds and tending to the sick.13 Let us raise our own lights high and use the power of transparent and reliable information to illuminate a better way forward for surgical teams, policymakers, and for the public, around the Far East and throughout the global healthcare enterprise.
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