Newly Published
Perioperative Medicine  |   May 2018
Anesthesia Care Team Composition and Surgical Outcomes
Author Notes
  • From the Department of Anesthesiology, Pain, and Perioperative Medicine (E.C.S.), the Center for Health Policy and the Center for Primary Care and Outcomes Research (J.M.), and the Department of Health Research and Policy (E.C.S., L.C.B.), Stanford University School of Medicine, Stanford University, Stanford, California; the Department of Analytics and Research Services, American Society of Anesthesiologists, Schaumburg, Illinois (T.R.M.); and the National Bureau of Economic Research, Cambridge, Massachusetts (L.C.B.).
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • This work was presented on May 5, 2017, in Washington, D.C., at the 63rd annual meeting of the Association of University Anesthesiologists.
    This work was presented on May 5, 2017, in Washington, D.C., at the 63rd annual meeting of the Association of University Anesthesiologists.×
  • Submitted for publication September 18, 2017. Accepted for publication May 1, 2018.
    Submitted for publication September 18, 2017. Accepted for publication May 1, 2018.×
  • Research Support: Supported by funding from the American Society of Anesthesiologists (ASA, Schaumburg, Illinois; to Dr. Sun, Dr. Baker, and Ms. Moshfegh). The ASA issued a request for proposals to three organizations, including Stanford, for a study to compare outcomes between anesthesia care teams with anesthesiologist assistants and anesthesia care teams with nurse anesthetists. Drs. Sun and Baker elected to respond to the request and prepared a bid including an outline of the study methodology, which they developed without input from the ASA. In all, the ASA received three bids. The decision on which bid to accept was made by the Executive Committee of the ASA, with Dr. Miller’s input. Dr. Miller is employed by the ASA.
    Research Support: Supported by funding from the American Society of Anesthesiologists (ASA, Schaumburg, Illinois; to Dr. Sun, Dr. Baker, and Ms. Moshfegh). The ASA issued a request for proposals to three organizations, including Stanford, for a study to compare outcomes between anesthesia care teams with anesthesiologist assistants and anesthesia care teams with nurse anesthetists. Drs. Sun and Baker elected to respond to the request and prepared a bid including an outline of the study methodology, which they developed without input from the ASA. In all, the ASA received three bids. The decision on which bid to accept was made by the Executive Committee of the ASA, with Dr. Miller’s input. Dr. Miller is employed by the ASA.×
  • Competing Interests: Dr. Miller is employed by the American Society of Anesthesiologists. Although all authors participated in the study design, data analysis, manuscript preparation, and publication decisions, the funding arrangement provided that the Stanford investigators—specifically Drs. Sun and Baker—had the final say over all elements of the study.
    Competing Interests: Dr. Miller is employed by the American Society of Anesthesiologists. Although all authors participated in the study design, data analysis, manuscript preparation, and publication decisions, the funding arrangement provided that the Stanford investigators—specifically Drs. Sun and Baker—had the final say over all elements of the study.×
  • Correspondence: Address correspondence to Dr. Sun: Perioperative and Pain Medicine, H3580, Stanford University Medical Center, Stanford, California 94305. esun1@stanford.edu. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Quality Improvement
Perioperative Medicine   |   May 2018
Anesthesia Care Team Composition and Surgical Outcomes
Anesthesiology Newly Published on May 29, 2018. doi:10.1097/ALN.0000000000002275
Anesthesiology Newly Published on May 29, 2018. doi:10.1097/ALN.0000000000002275
Abstract

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.