The lessons of the National Confidential Enquiry into Perioperative Deaths

The National Confidential Enquiry into Perioperative Deaths (NCEPOD) uses an annual sample of deaths occurring within 30 days of a surgical operation in England, Wales and Northern Ireland to identify remedial factors in the practice of anaesthesia and surgery. In its reports, through a process of peer review, it makes recommendations for improvement. Inevitably in a sample based on deaths, the majority of patients are old and sick and have a low expectation of survival in the longer term. They are therefore very much at high risk for their surgery and anaesthesia. Many have coexisting medical conditions, particularly cardiac, and these are not always well managed pre-operatively. If these high-risk patients are to benefit from the advances in modern anaesthetic, surgical and medical practice, then better organization and provision of services will be required. Information collected by NCEPOD suggests that current arrangements spread acute services too thinly resulting in an unsatisfactory dependence on trainees to sustain emergency care. There are also inadequacies in the provision of intensive treatment unit and high-dependence unit beds.