In a 20-year retrospective study of deaths on an ophthalmic service, with an autopsy rate of 80% and data on the entire patient population for the period, it was possible to determine specific risk factors. An adjusted mortality of 0.10% for 47,000 procedures confirmed that death after ophthalmic surgery was much less common than after general surgery. Though the mortality per procedure among patients who had local and general anesthesia was nearly equal, the comparison was heavily dependent on patient selection. Death after general anesthesia was rare among young, healthy patients, but the rate increased with age. Local anesthesia seemed safer in older patients. Retinal detachment patients were at significantly greater risk than the general population, with gas anesthesia at an older age and prolonged bed rest probably contributing to higher mortality. Prophylactic measures might reduce this complication. Preoperative medical evaluation was of occasional value in identifying high-risk patients.
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