Anesthesia Patient Safety: Next Steps to Improve Worldwide Perioperative Safety by 2030

Mark A. Warner, MD; Daniel Arnal, MD; Daniel J. Cole, MD; Rola Hammoud, MD; Carolina Haylock-Loor, MD; Pedro Ibarra, Acad, MD, MSc; Muralidhar Joshi, MBBS, MD; Fauzia A. Khan, FRCA; Konstantin M. Lebedinskii, DSc Med; Jannicke Mellin-Olsen, MD, DPH; Katsuyuki Miyasaka, MD, PhD; Wayne W. Morriss, MBChB; Bisola Onajin-Obembe, FWACS, PhD; Robinson Toukoune, MMed; Patricia Yazbeck, MD


Anesth Analg. 2022;135(1):6-19. 

In This Article

Abstract and Introduction


Patient safety is a core principle of anesthesia care worldwide. The specialty of anesthesiology has been a leader in medicine for the past half century in pursuing patient safety research and implementing standards of care and systematic improvements in processes of care. Together, these efforts have dramatically reduced patient harm associated with anesthesia. However, improved anesthesia patient safety has not been uniformly obtained worldwide. There are unique differences in patient safety outcomes between countries and regions in the world. These differences are often related to factors such as availability, support, and use of health care resources, trained personnel, patient safety outcome data collection efforts, standards of care, and cultures of safety and teamwork in health care facilities. This article provides insights from national anesthesia society leaders from 13 countries around the world. The countries they represent are diverse geographically and in health care resources. The authors share their countries' current and future initiatives in anesthesia patient safety. Ten major patient safety issues are common to these countries, with several of these focused on the importance of extending initiatives into the full perioperative as well as intraoperative environments. These issues may be used by anesthesia leaders around the globe to direct collaborative efforts to improve the safety of patients undergoing surgery and anesthesia in the coming decade.


One hundred years ago in its inaugural issue, Current Researches in Anesthesia & Analgesia (subsequently named Anesthesia & Analgesia) published an anesthesia patient safety article, "Morbidity and Mortality in Obstetrics as Influenced by Anesthesia."[1] In the past century, the Journal has continued to serve globally as an important source of novel anesthesia and perioperative patient safety reports.

Clearly, anesthesia patient safety has improved dramatically in the past century. This is particularly true since seminal reports on critical incidents in anesthesia care,[2–4] the promulgation of anesthesia standards of care,[5–7] and the modern evolution of the anesthesia patient safety movement in America and other countries in the late 1970s and throughout the 1980s.[8] However, the distribution of improvement has not been consistent globally, and low- and middle-income countries, as defined by the World Bank,[9] currently have much higher intraoperative and perioperative mortalities and complication rates than high-income countries.[10,11]

Anesthesiologists, other anesthesia providers, surgeons and other proceduralists, health researchers, and patient safety scientists around the world have worked diligently in coordinated efforts over the past several decades to improve anesthesia patient safety, including in low- and middle-income countries. For example, the World Federation of Societies of Anaesthesiologists (WFSA) first endorsed standards of intraoperative anesthesia care in 1992.[12] These standards have since evolved,[13] and in 2018, the WFSA and the World Health Organization together developed international standards for the safe practice of anesthesia.[14]

In this article, the authors provide their perspectives on the current state of anesthesia patient safety in a diverse set of countries from around the world and issues that they hope to address in the coming decade. These countries are representative of the range of health care resources available in nations around the world. The resource levels of the countries represented by these authors are reflected in the World Bank classification system (Table 1).[9] Estimated populations for the countries in 2020 may be found in data from the United Nations' Population Division and are used in the World Bank estimates of gross national product per capita.[15] To approximate anesthesia care resources within nations, the WFSA's ratio of number of physician anesthesia providers per 100,000 population in 2016 is provided.[16,17]

The countries profiled in this article were randomly chosen to represent a range of health care resourcing. To provide an expansive representation, they come from each major region of the world as described by the World Bank.[9] The authors for the country sections in this article are physician anesthesia leaders in their national societies (Figure). Their perspectives are presented in the countries' alphabetical order.


The authors and their countries. These countries represent all 4 gross national income per capita classifications and all global region categories of the World Bank.9