“Carpe diem.” –Daniel Sessler, MD

Okay, Dan Sessler isn’t the first person to say “carpe diem” (“seize the day”). Evidently that honor goes to Horatius, who said that in a poem published in 13 B.C. (asamonitor.pub/4ajj9Vf). However, Dr. Sessler has repeatedly urged our profession to rise to the challenge of reducing patient mortality within the first 30 days after surgery, often with the exhortation “Carpe diem!” (e.g., his 2016 Severinghaus Lecture “Lost in Translation,” his 2021 FAER-Helrich Lecture “Reversing Postoperative Mortality,” and his 2022 editorial in the British Journal of Anaesthesia “Anaesthesia’s legacy, carpe diem” (Br J Anaesth 2022;128:413-5).

Rather than seizing the day, I’m seizing the May issue of the ASA Monitor to advocate that our profession devote substantial time, intellectual energy, research, and clinical attention to reducing 30-day mortality after surgery. This is a big deal. As noted by Drs. Sessler and Jarkas in “Postoperative Mortality – And How to Prevent It,” mortality within 30 days of surgery accounts for approximately 4 million deaths worldwide every year – the third-leading cause of death globally. Perhaps many of those deaths are unavoidable (e.g., traumatic death refractory to surgical intervention). However, Drs. Sessler and Jarkas offer evidence that many of these deaths are preventable. I share their view that anesthesiologists have exactly the right training in clinical medicine, critical care medicine, epidemiology, and outcomes research to address this problem. Drs. Sessler and Jarkas end their overview with the exhortation carpe diem!

This issue of the ASA Monitor looks at several aspects of postoperative death. Drs. Ibrahim and Flood review parturient death following delivery (albeit within 42 days, which is the standard in the obstetric literature). They document the profound role of geography (both international and national), race, and socioeconomic disparities in maternal mortality. They emphasize that preventing mortality after delivery starts months earlier with identifying and treating the well-understood risk factors in expectant mothers.

Drs. Chatterjee and Nasr look at deaths in children after surgery. The Pediatric Risk Assessment (PRAm) score was designed to predict the risk of perioperative mortality. Understanding the risk is an excellent first step in reducing risk. As the authors lament, perioperative mortality in children is approximately 0.3% and “has not changed over the last 10 years.” How can we accept this status quo?

Drs. Hicks, Palermo, and Khanna take a deep dive into the role of postoperative ward monitoring on 30-day mortality. As they note, previous clinical trials “demonstrated a high incidence of prolonged, serious hypotension and tachycardia” after surgery, events often missed with our current standard of care for postoperative patients: intermittent monitoring of vital signs. How can we allow serious cardiovascular compromise to be frequently missed after surgery when these events are highly associated with substantial increases in postoperative mortality?

Randall Clark, 2021-2022 ASA President and Board Chair of the Anesthesia Quality Institute, describes the role of ASA advocacy in reducing 30-day mortality. ASA has an active program of advocacy with state and federal governments. Part of this advocacy is bringing the message to legislatures and executive branches that anesthesiologists have an expanding role in addressing important public health issues. Advances pioneered by our profession have reduced intraoperative mortality to nearly zero. As Dr. Clark explains, our work is not done as long as death within 30 days of surgery is a leading cause of mortality.

We have so much to be proud of in our history! In the 1990s, our profession was lauded as a leading example of patient safety by the Institute of Medicine, who noted “anesthesiology has successfully reduced anesthesia mortality rates from two deaths per 10,000 anesthetics administered to one death per 200,000-300,000 anesthetics administered” (To Err Is Human: Building a Safer Health System. 2000). A recent review documents how we have continued to champion patient safety in the decades since (Front Med 2022;9:980684).

More recently, our profession was widely praised in the popular press for our dedication and innovation during the SARS-CoV-2 pandemic. Pictures of anesthesiologists caring for patients appeared on the covers of magazines, and our innovations were widely documented (asahq.org/madeforthismoment/innovation/; ASA Monitor 2020;84:44).

While these recognitions are affirming, we can’t say “mission accomplished” as long as many of our patients are dying in the first 30 days after surgery. Rephrasing a common ASA refrain, we are made for this challenge. This issue of the ASA Monitor outlines some of the challenges in reducing 30-day mortality after surgery and provides thoughts on how our broad skills can be applied.

We have transformed health care in the past. We can transform health care in the future. Carpe diem.