Chiang Mai Med J 2009;48(1):15-24. Address requests for reprints: Tanyong Pipanmekaporn, M.D., Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand: E-mail: Received 12 February, 2009, and in revised form 3 April, 2009 Original article PERIOPERATIVE MORTALITY AND RISK FACTORS IN CARDIAC SURGERY, A REVIEW OF 3,822 CASES AT THE NORTHERN CARDIAC CENTER, THAILAND Tanyong Pipanmekaporn, M.D., 1 Nutchanart Bunchungmonkol, M.D., 1 Suphachai Chuaratanaphong, M.D., 2 Yodying Punjasawadwong, M.D., 1 Ananchanok Saringcaringkul, M.D., 1 Passakorn Sawaddiruk, M.D. 1 1 Department of Anesthesiology, 2 Department of Surgery, Faculty of Medicine, Chiang Mai University Abstract Objective To determine the incidence, causes, risk factors of perioperative mortality in cardiac surgery at a tertiary referral center. Methods All cardiac patients, who died intraoperatively or within a period of 24 hours after anesthesia between January 1, 2003 and December 31, 2006 were identified and reviewed by at least 2 independent reviewers. Results From a database of 3,822 anesthetics, the overall incidence of perioperative death was 11.0 (95% CI: 7.9 - 14.8) per 1,000 and the incidence of perioperative death in closed and open heart surgery was 11.5 (95% CI: 6.8 -18.2) and 10.6 (95% CI: 6.8 -15.8) per 1,000 anesthetics, respectively. Two out of 42 cases were associated with anesthesia; one being due to complication of the central line access and the other caused by respiratory insufficiency due to early extubation. ASA physical status 4 and 5, patients with cyanotic heart disease, operations with a duration of cardiopulmonary bypass for more than 3 hours and emergency operations independently associated with perioperative mortality. The most common causes of death were cardiovascular problems and hypoxemia. More than half of these deaths occurred in the cardiac intensive care unit (78%) and most of them were unpreventable (88%). Conclusion The majority of perioperative mortalities in cardiac operations were caused by factors unrelated to anesthesia and more common in patients with ASA physical status 4 and 5, cyanotic heart disease, open heart surgery with a duration of cardiopulmonary bypass for more than 3 hours and emergency operations. Improvement in supervision and the use of an ultrasound machine during central venous monitoring, and implementation of extubation criteria and algorithm, are suggested as preventive strategies for anesthesia related death. Chiang Mai Medical Journal 2009;48(1):15-24. Keywords: mortality, anesthesia, complications, epidemiology, catheterization, cardiac surgical procedure, risk factor