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The World Federation of Societies of Anaesthesiologists, International Anesthesia Research Society, and Anesthesia & Analgesia: a shared global vision.

• Volume 120 • Number 4 www.anesthesia-analgesia.org 721 Copyright © 2015 International Anesthesia Research Society DOI: 10.1213/ANE.0000000000000639 This month sees the launch of a new Global Health section in Anesthesia & Analgesia, and a new type of manuscript, “Global Health Reports” in A&A Case Reports, which marks the creation of an important affiliation between the World Federation of Societies of Anaesthesiologists (WFSA) and the International Anesthesia Research Society (IARS). The links between the WFSA and IARS go back many years. Francis Hoeffer McMechan founded the IARS, and was a very keen advocate of a worldwide organization for anesthesia. The first World Congress of Anesthesiologists was held in 1955. At the end of the meeting, 26 national societies of anesthesiology formally launched the WFSA. The first president of the WFSA was Harold Griffith, a former president of IARS (1948). Dr. Griffith was a pioneer in anesthesia who introduced curare into clinical practice. Today, the WFSA is an affiliation of 125 member societies from 140 countries and remains true to the vision of the founding members, supporting training fellowships, the journal Update in Anaesthesia and Anaesthesia Tutorial of the Week (www.wfsahq.org). The patient comes first. This is the basic principle underlying every editorial decision of Anesthesia & Analgesia. This is reflected in the mission statement of the Journal: “Anesthesia & Analgesia exists for the benefit of current and future patients under the care of health care professionals engaged in the disciplines broadly related to anesthesiology: perioperative medicine, critical care, and pain management. The Journal furthers the care of these patients by reporting the fundamental advances in the sciences of these clinical disciplines and by documenting the clinical, administrative, and educational advances that guide therapy.” The patient comes first. That is the fundamental view of the WFSA, whose mission is “To improve patient care by uniting anaesthesiologists around the world. We deliver our mission through programmes that are implemented in partnership with National Societies of Anaesthesiology and other organisations that share our objectives. We work with the World Health Organisation (WHO), with governments, with other standard setters, with surgical organisations, with NGOs (nongovernmental organizations), with hospitals and with training centres and we welcome partnerships with organisations that support safe surgery and recognise that safe anaesthesia is an essential element of the same.” The patient comes first. It sounds good, but what metrics suggest that we “walk the walk” and actually put patients first? Bainbridge and colleagues conducted a systematic review of perioperative and anesthetic-related mortality published up to 2011.1 They reviewed all studies, in any language, that reported perioperative outcomes after surgery in patients undergoing general anesthesia. They only considered studies with at least 3000 subjects. A total of 87 studies were included in their analysis, describing outcomes for >21.4 million patients. Most studies reported outcomes in the perioperative period or within the first 24 to 48 hours after surgery. Bainbridge et al. found that mortality solely attributable to anesthesia, or where anesthesia was a contributory factor decreased progressively over time, despite a significant increase in baseline ASA status each decade. This is a great credit to our profession, to the improvements in training and education that have allowed us to increase the safety of anesthesia and surgery. It is a tribute to the systems we have put together to promote patient safety. It is a tribute to the device and drug industries who have advanced our technologies and therapeutic options. However, before we declare “mission accomplished” and switch to more pressing health care concerns, it is important to dig a little deeper. The United Nations Human Development Index (HDI) is a measure based on life expectancy, literacy, education, and per capita income. Improvements in anesthesia-related mortality have only been seen in countries with a high HDI. The risk of dying from an anesthesia-related cause has increased over time in the poorer corners of the planet. In the Bainbridge et al. study, the risk of dying of anesthesia complications was 3 times higher in low-HDI countries compared to high. This is in addition to patients in low-HDI countries having The World Federation of Societies of Anaesthesiologists, International Anesthesia Research Society, and Anesthesia & Analgesia: A Shared Global Vision