Anaesthesia care team improves outcomes in surgical patients compared with solo anaesthesiologist

Abstract

BACKGROUND In anaesthesiology, little attention has been drawn to the role of anaesthesia nurses as support personnel on quality of care. OBJECTIVES To compare an anaesthesiologist alone (solo anaesthesiologist) with an anaesthesia care team (anaesthesiologist and anaesthesia nurse). DESIGN An observational study. SETTING A single centre study. PARTICIPANTS Anaesthesiologists and anaesthesia nurses. INTERVENTION Anaesthesia performed by solo anaesthesiologists compared with anaesthesia care teams. MAIN OUTCOME MEASURES 30-day postoperative mortality and hospital length of stay. Propensity score matching was performed by logistic regression to adjust for baseline differences between the two groups and pairs of perfectly matched patients were formed. RESULTS Anaesthesia was performed by solo anaesthesiologists in 2832 patients and by an anaesthesia care team in 2842 patients. Matching with 2095 pairs of perfectly matched patients was formed. The two groups were comparable in respect of sex and duration of anaesthesia but differed notably for age, American Society of Anesthesiologists' physical status score and type of surgery. Logistic regression showed a significantly lower 30-day mortality rate for the anaesthesia care teams compared with solo anaesthesiologists (0.76 vs. 1.56%, P ¼ 0.0014). Length of hospital stay was also significantly reduced when an anaesthesia nurse was present (4.9 AE 10.1 vs. 5.6 AE 11.5 days, P ¼ 0.0011). CONCLUSION Anaesthesia given by teams of anaesthesiologists and anaesthesia nurses is associated with decreased 30-day postoperative mortality and shorter length of stay when compared with solo anaesthesiologists. Even without any demonstration of causality, this emphasises the benefits of the anaesthesia care team model. TRIAL REGISTRATION CCB 325201730849.

Description of practices and complications in the French centres that participated to APRICOT: A secondary analysis

“…The second independent factor of interest consisted on the presence of an anaesthetic nurse. This is also consistent with a recent study in adults that found that the presence of a team consisting on a physician and nurse anaesthesiologists, in comparison with a solo anaesthesiologist, was associated with a 30 days decrease in mortality (22). The reasons advocated for explaining the results obtained in the latter were the optimisation of intraoperative care with a resulting long-lasting improvement in the overall outcomes, and the same explanation can also apply to our finding.…”

Association of Anesthesiologist Staffing Ratio With Surgical Patient Morbidity and Mortality

“…When these findings are considered, it is important to judge increased overlap balanced against potential efficiency and access benefits to assess how much overlap may be appropriate. This study is limited to physician-led anesthesiologist care teams; previous studies have shown that anesthesiology care teams improve outcomes compared with anesthesiologists working alone . Fifth, this study did not investigate operations with anesthesiologists supervising physicians in training by limiting resident involvement to less than 25% in each operation.…”

“…This study is limited to physician-led anesthesiologist care teams; previous studies have shown that anesthesiology care teams improve outcomes compared with anesthesiologists working alone. 36 Fifth, this study did not investigate operations with anesthesiologists supervising physicians in training by limiting resident involvement to less than 25% in each operation. Sixth, routinely collected electronic health record data have known limitations, which were mitigated by the MPOG registry's strict data quality controls.…”

Impact of collaborative physician-pharmacist stewardship strategies on prophylactic antibiotic practices: a quasi-experimental study

“…In a study of the University Hospital of Charleroi in Belgium, post-operative mortality rates within 30 post-operative days were 1.1% [ 2 ]. In this hospital, risk factors of post-operative mortality were identified as the absence of an anesthesia nurse, American Society of Anesthesiologists scores (ASA scores) > 2, emergency, duration of surgery and rate of admission to critical care unit [ 2 , 3 ].…”