Trends in perioperative mortality in the United States: A 25 year retrospective analysis

BACKGROUND: Perioperative mortality, defined as death within 30 days of surgery, is a significant global health concern. Despite improvements in surgical practices and anesthesia care, it continues to account for millions of deaths annually. This study examines trends in perioperative mortality in the United States from 1999 to 2023, highlighting demographic and regional differences. METHODS: A retrospective analysis of perioperative-associated death in the United States during 1999-2023 based on CDC WONDER data from death certificates was performed. Perioperative mortality was defined in the Multiple Cause of Death Public Use File by ICD-10 codes for operative and anaesthetic complications (T98.3, T80-T88, Y83-Y84). The 2000 U.S. standard population computed age-adjusted mortality rates (AAMRs) by 100,000 population. Trend was investigated overall and across age, sex, race/ethnicity, region of the country, and urbanization level. The temporal pattern was examined by Joinpoint regression and calculated annual percent changes (APCs) across 95% confidence intervals. RESULTS: Between 1999 and 2023, there were 627,730 perioperative-related deaths in the U.S. Overall, the AAMR saw a decline from 10.48 in 1999 to 4.67 in 2023, with a temporary rise in between. The highest mortality rate was observed in the 65 years and older age group, which had an AAMR of 8.93 in 2023. Men consistently exhibited higher AAMRs compared to women, with rates decreasing from 13.01 in men versus 8.74 in women in 1999 to 5.69 in men versus 3.87 in women in 2023. NH African American individuals recorded the highest AAMR in 1999 at 13.93, while Hispanics had the highest AAMR of 10.68 in. Significant geographical and regional differences were noted, with the highest AAMRs reported in the West (4.72) and nonmetropolitan areas (17.73) compared to other census regions and metropolitan areas. California had the highest absolute burden of death, while the lowest was recorded in Wyoming. CONCLUSION: Perioperative mortality in the US decreased from 1999 to 2023, but still remained high due to disparities by age, sex, race, ethnicity, and geography, with older individuals, men, minority groups, and nonmetropolitan residents bearing disproportionate burdens.