Shifting Patterns in Anesthesia-Related Mortality: A Two-Decade National Study in the United States, 1999 to 2024.

OBJECTIVE: To explore trends in mortality from anesthesia-related complications, stratified by age, sex, race, region, and urbanization in the United States from 1999 to 2024, using data from the Centers for Disease Control and Prevention (CDC) Wide-Ranging Online Data for Epidemiologic Research (WONDER) Multiple Cause of Death database. DESIGN: A national database retrospective cohort study of mortality trends SETTING: United States, 1999 to 2024 PARTICIPANTS: Deidentified records of all recorded deaths in the United States between 1999 and 2024 in which anesthesia-related complications were listed as a contributing or underlying cause of death INTERVENTIONS: Anesthesia-related deaths in the United States between 1999 and 2024 were analyzed using the CDC WONDER Multiple Cause of Death database. Deaths were identified by International Classification of Diseases, Tenth Revision codes specific to anesthesia complications. MEASUREMENTS: Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated, and temporal trends were assessed using joinpoint regression, stratified by sex, race/ethnicity, region, urbanization, age, state, and place of death. MAIN RESULTS: A total of 16,371 anesthesia-related deaths were identified. The AAMR increased from 0.09 in 1999 to 0.45 in 2024 (average annual percent change, 5.89; 95% confidence interval, 5.28-6.93; p < 0.001), demonstrating a significant biphasic increase, followed by a progressive decline between 2021 and 2024. Mortality was consistently higher among males (0.28 vs 0.13 in females) and non-Hispanic Black individuals (AAMR, 1.19). Geographically, the Northeast region and the District of Columbia had the highest rates, and metropolitan areas had higher AAMRs than nonmetropolitan areas. By 2024, more anesthesia-related deaths occurred at home than in hospitals. CONCLUSIONS: Anesthesia-related mortality in the US remained stable until 2014 but has since risen significantly, disproportionately affecting males, non-Hispanic Black individuals, and residents of the Northeast US.