The Thai Anesthesia Incidents Study (THAI Study) of Perioperative Death : Analysis of Risk Factors
Somrat Charuluxananan MD*, Thitima Chinachoti MD**, Aksorn Pulnitiporn MD***, Sireeluck Klanarong MD****, Oraluxna Rodanant MD*,Surasak Tanudsintum MD*****
Affiliation : *Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University ** Department of Anesthesiology, Siriraj Hospital, Mahidol University *** Department of Anesthesiology, Khon Kaen Regional Hospital, Khon Kaen **** Department of Anesthesiology, Buddhachinaraj Hospital Phitsanulok ***** Department of Anesthesiology, Phramongkutklao College of Medicine, Bangkok, Thailand
Background : National statistical data of mortality and morbidity related to anesthesia have not been reported.
The need to comprehensively examine the cause of death as well as other adverse events prompted the first
national study in Thailand.
Materials and Methods : In the Thai Anesthesia Incidents Study (THAI Study), a prospectively defined cohort of
patients who underwent anesthesia from February 1, 2003 to January 31,2004 (n=163,403) was studied. All
consecutive patients who died intraoperatively or within the period of 24 hr after anesthesia were classified to
determine a relationship with anesthesia by 3 independent reviewers. These data were further analysed to
identify contributing factors.
Results :The incidence of 24-hr perioperative death, anesthesia directly related and anesthesia partially
related death per 10,000 anesthetics was 28.2 (95% CI 25.7-30.8), 1.7 (95% CI 1.1-2.3) and 4.0 (95% CI 3.1-
5.0) respectively. Of 462 deaths, 28 cases (6.5%), 66 cases (14.3%), 61 cases (3.3%), 399 cases (86.7%) and
104 cases (22.6%) were anesthesia directly related, anesthesia partially related, surgical related, patient
disease related and system or management related to perioperative death. The common main causes of death
were exangination (42.4%), traumatic brain injury (14.3%), sepsis (13.6%), heart failure (5.0%) and
hypoxia (5.0%).
Conclusion : This study shows incidence of 24-hr perioperative death of 1:354 which is comparable with other
studies. Quality assurance activity, prevention of human failure and equipment failure, system improvement
of perioperative care, availability of recovery room, intensive care unit, efficient blood bank and adequate
number of MD. anesthesiologists are suggestive corrective strategies.
Keywords : Anesthesia, Mortality, Complication, Risk, Quality, Epidemiology
