Increased anesthesiologist coverage responsibilities associated with increased surgical patient mortality and significant morbidity

1. This retrospective cohort study with 866,453 adults showed that with an increase in overlapping anesthesiologist responsibilities, the 30-day risk of morbidity and mortality increased for surgical patients.

2. Future studies should evaluate the consequences of an anesthesiologist covering multiple operating rooms under the direct care of resident anesthesiologists.

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Study rundown: Overlapping responsibilities across different medical specialties have been linked to poor patient outcomes. However, this has not been well studied in anaesthesia, where the practice is widespread; In particular, overlapping responsibilities occur in models where certified nurse anesthetists (CRNAs), anesthesia assistants, or residents in the anesthesiology department are supervised by an anesthesiologist. This retrospective cohort study evaluated whether there was an association between varying anesthetic recruitment ratios and major patient morbidity or mortality. The Multicenter Perioperative Outcome Group (MPOG) database was used to obtain data from 23 hospitals in 18 US states from January 1, 2010 to October 31, 2017. Operations were included if the anesthesiologist supervised rooms under the care of direct CRNAs or those . With less than 25% of residents participating; Operations were excluded if care was provided directly by the staff anesthesiologist. Propensity score matching was used to develop groups; The clusters were established depending on the number of operations covered by the anesthesiologist (group 1: staffing ratio 1; cluster 1-2: staffing ratio between 1 and 2; cluster 2-3: staffing ratio between 2 and 3; cluster 3-4: staffing ratio between 1 and 2; between 3 and 4). The primary outcome was a composite of 30-day mortality and six major surgical co-morbidities (cardiac, respiratory, gastrointestinal, urinary, hemorrhagic, and infectious). Compared to group 1-2, patients in group 2-3 had a 4% relative increase (adjusted odds ratio [AOR]: 1.04 [95% CI: 1.01-1.18]; s= 0.02) and those in group 3-4 had a 14% relative increase (AOR: 1.15 [95% CI: 1.09-1.21]; s<0.001) at risk of significant morbidity or mortality. In addition, group 3-4 was significantly more likely to suffer morbidity or mortality than group 2-3 (area of ​​responsibility: 1.10 [95% CI: 1.04-1.16]; p = 0.001). In general, as the coverage of staggered anesthetists increased, so did the surgical patient morbidity and 30-day risk of death. Despite the slight increases in risk, these results are still statistically significant; Given the millions of surgeries that are performed each year, these findings have significant implications. One limitation of this study, however, is the strict exclusion criteria, such as limiting resident participation to less than 25% in the operating room to be included in the study; Further research should consider the consequences of oversight for multiple residents to better understand these effects.

Click to read the study at JAMA Surgery

Click to read the accompanying editorial in JAMA

Related reading: Association of intervening surgery with perioperative outcomes

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