To the Editor.—
Mortality outcome data from a single anesthesia practice involving multiple surgical procedures are interesting and important. However, one conclusion of Cohen et al1 is that the patient's physical status and surgical risk factors are much more important in determining 7-day mortality than are anesthesia factors (number of anesthetic drugs administered, anesthetic technique, duration of anesthesia, and experience of the anesthesiologist). Some of the data do not support this conclusion.First, comparing the relative odds of mortality in nonmajor surgical cases with American Society of Anesthesiologists physical status scores of 1 through 3 (Table 3 in the article by Cohen et al), anesthesia-related factors are not less important in predicting mortality than are the patient's physical status or surgical factors. The authors do not report anesthetic technique—related relative odds of dying with the lowest (spinal anesthesia) and highest (narcotic alone or narcotic-with-inhalational anesthetic) odds. When we computed
Kissin I, Bradley EL, Reves JG. Does Anesthesia Contribute to Operative Mortality?. JAMA. 1989;262(7):902. doi:10.1001/jama.1989.03430070050024
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