Joan Rivers' Death Highlights Risks of Surgical Complications

Although the incidence of perioperative cardiac arrest primarily attributable to anesthesia is less than 1 per 10,000 anesthetics, it represents the most serious complication and can have devastating results, as witnessed by the recent death of comedian Joan Rivers.

Article updated at 2:49 am on Sept. 5, 2014.

Although the incidence of perioperative cardiac arrest primarily attributable to anesthesia is less than 1 per 10,000 anesthetics, according to the Mayo Clinic, it represents the most serious complication and can have devastating results, as witnessed by the recent death of comedian Joan Rivers.

The 81-year-old’s heart stopped while under anesthesia during a throat surgery at a Manhattan clinic on Aug. 28, according to the New York Times. Following the complication, Rivers was hospitalized and put on life support. Although her daughter earlier said there was a chance her mother could be taken off life support by the weekend, Rivers passed away on Thursday, Sept. 4.

“Even though this is a very highly publicized event, it’s something that is very unusual,” otolaryngologist Scott Kay, MD, said. “In terms of probable risk, it’s not very likely that someone is going to have a catastrophic event with a procedure like that in any particular point in time. Having said that, it’s important for physic to always prepare for the catastrophic event. This way they can avoid an outcome that might result in death.”

The surgery was apparently a minor, elective procedure, but the complications Rivers suffered reminds patients and providers that there are always risks to be considered during surgery. Some of the factors that can increase the risk of cardiac arrest during surgery include coronary artery disease, cardiomyopathy, congenital heart disease, and heart failure.

“Being 81 [years old] is a risk factor, itself,” internist Simon Murray, MD, said. “While we will never know — I don't think — the details, it seems to me that when you operate [on] a person's vocal chords, you run the risk of having laryngospasm paralysis of the vocal chords, which will lead to respiratory failure if not corrected immediately.”

Patients who suffer sudden cardiac arrest that lasts more than 10 minutes rarely survive, and those who do may show signs of brain damage.

Despite the adoption of surgical safety checklists, they are not associated significant reductions in mortality or surgical complications, according to a March 2014 study in the New England Journal of Medicine. A more recent study in Anesthesiology found that while surgical checklists reduce postoperative complications, they have no significant effect on mortality.

As improvements in surgical and anesthetic techniques significantly decrease mortality rates in noncardiac surgery, preoperative cardiac stress testing is not recommended unless the patient is identified as high risk. As part of the Choosing Wisely campaign, the American Society of Anesthesiologists recommended against diagnostic cardiac testing or cardiac stress testing in asymptomatic stable patients with known cardiac disease who are undergoing low or moderate risk non-cardiac surgery.

“I would try to give all the available information to the patient in terms of what potential complications do exist,” Kay said. “I would also remind patients that there are risks involved with almost everything, including getting into their car every day.”