Anesthesia Care Team Composition and Surgical Outcomes

Abstract

Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background In the United States, anesthesia care can be provided by an anesthesia care team consisting of nonphysician providers (nurse anesthetists and anesthesiologist assistants) working under the supervision of a physician anesthesiologist. Nurse anesthetists may practice nationwide, whereas anesthesiologist assistants are restricted to 16 states. To inform policies concerning the expanded use of anesthesiologist assistants, the authors examined whether the specific anesthesia care team composition (physician anesthesiologist plus nurse anesthetist or anesthesiologist assistant) was associated with differences in perioperative outcomes. Methods A retrospective analysis was performed of national claims data for 443,098 publicly insured elderly (ages 65 to 89 yr) patients who underwent inpatient surgery between January 1, 2004, and December 31, 2011. The differences in inpatient mortality, spending, and length of stay between cases where an anesthesiologist supervised an anesthesiologist assistant compared to cases where an anesthesiologist supervised a nurse anesthetist were estimated. The approach used a quasirandomization technique known as instrumental variables to reduce confounding. Results The adjusted mortality for care teams with anesthesiologist assistants was 1.6% (95% CI, 1.4 to 1.8) versus 1.7% for care teams with nurse anesthetists (95% CI, 1.7 to 1.7; difference −0.08; 95% CI, −0.3 to 0.1; P = 0.47). Compared to care teams with nurse anesthetists, care teams with anesthesiologist assistants were associated with non–statistically significant decreases in length of stay (−0.009 days; 95% CI, −0.1 to 0.1; P = 0.89) and medical spending (−$56; 95% CI, −334 to 223; P = 0.70). Conclusions The specific composition of the anesthesia care team was not associated with any significant differences in mortality, length of stay, or inpatient spending.

Variability in Anesthesia Models of Care in Cardiac Surgery

“…While Posner's findings suggested that in a large university program outcomes were not impacted by team composition, productivity, or concurrency, she acknowledged that the role of specific individuals was not studied. More recent work has supported these findings by reviewing a national claims database of 443,000 Medicare beneficiaries [13]. In this study, there were no significant differences observed between different care models and costs, length of stay, and/or mortality.…”

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

“…The influence on outcome of other factors, such as complexity of the interventional procedure or emergency intervention, will have to be investigated. 6,[18][19][20][21] In conclusion, results of the present retrospective study show that the risk of 30-day death and hospital LOS are substantially lower if an anaesthesia nurse is present and supervised by an anaesthesiologist, compared with a solo anaesthesiologist. The research shows an interesting association.…”

A Population-based Comparative Effectiveness Study of Peripheral Nerve Blocks for Hip Fracture Surgery

“…A common type of instrumental variable is called the hospital preference instrumental variable, which has been used in previous studies in perioperative medicine. 38 This approach assumes that the local practice pattern (in our case the proportion of hip fracture patients at each participant's hospital who received a peripheral nerve block Copyright © 2019, the American Society of Anesthesiologists, Inc. Unauthorized reproduction of this article is prohibited.…”