In their analysis, Bainbridge's group found that although more high-risk and complicated surgeries are being done now than before, the odds of dying after being given a general anesthetic has dropped about 90 percent.
Before the 1970s, about 357 of every 1 million patients died, but from the 1990s to 2000s that number dropped to 34 patients per 1 million.
Over the same period, the risk of dying in the first 48 hours after surgery dropped about 88 percent, from just over 10,000 per million before the 1970s to nearly 1,200 per million in the 1990s-2000s, the investigators found.
Although these advances were seen all over the world, two to three times more patients survive surgery in developed countries than do in developing countries, Bainbridge said.
There are several reasons for this dramatic decline, one expert said.
"One obvious factor is advances in medicine in a culture of safety," said Dr. Michael Avidan, a professor of anesthesiology and surgery and division chief of cardiothoracic anesthesia and cardiothoracic intensive care at Washington University School of Medicine in St. Louis. He co-authored an accompanying journal editorial.
"We have safer drugs, we have better monitoring, we have better training, we have better safety drills," Avidan said. "Many of these advances are fairly low-tech and have immediate applicability throughout the world."
These include surgery checklists, and more practice and training, as well as better communication among members of the surgical team, he noted.
Most deaths during surgery or shortly after are not the result of just one failing, he added.
Avidan also noted that while deaths after surgery have declined, sometimes these are only "deaths deferred," as the patient is sometimes so sick or frail that he or she is likely to die within a month or two after surgery.
Another paper in the same journal issue showed the stand
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