To the Editor:—

Lagasse found an anesthesia-related mortality rate of 1 per 13,000 among 184,472 anesthetics administered to patients with American Society of Anesthesiologists Physical Status 1–5 across two hospitals. 1According to the peer review process by which the cause of each perioperative death was classified, deaths attributable to “limitation of supervision” were not counted as anesthesia-related. For example, if an “attending anesthesiologist is unable to prevent a resident anesthesiologist from committing a human error because of multiple supervisory responsibilities,” the resulting death was classified as a “System Error” and thus not related to anesthesia. However, it would not be unreasonable for patients to view any death caused by a physician administering anesthesia to be anesthesia-related, whether a fatal error was caused by a resident anesthesiologist or an attending anesthesiologist.

Because the perspective of patients may differ from the opinion of anesthesiologists in this regard, and because Lagasse's analyses are otherwise compelling, it would be useful to know the death rate calculated from his data set with perioperative mortality attributable to “limitation of supervision” classified as anesthesia-related.

Lagasse RS: Anesthesia safety: Model or myth? A review of the published literature and analysis of current original data. A nesthesiology 2002; 97: 1609–17