Newly Published
Editorial  |   February 2020
Implications of Practice Variability
Author Notes
  • From the Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.
  • 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).×
  • Accepted for publication January 2, 2020.
    Accepted for publication January 2, 2020.×
  • Correspondence: Address correspondence to Dr. Sessler: DS@OR.org
Article Information
Editorial / Cardiovascular Anesthesia / Pediatric Anesthesia / Respiratory System / Quality Improvement
Editorial   |   February 2020
Implications of Practice Variability
Anesthesiology Newly Published on February 11, 2020. doi:https://doi.org/10.1097/ALN.0000000000003162
Anesthesiology Newly Published on February 11, 2020. doi:https://doi.org/10.1097/ALN.0000000000003162
Clinicians strive to practice evidence-based medicine. The difficulty is that little routine care has actually been validated in robust clinical trials. Consequently, many generally accepted clinical approaches are neither supported nor refuted by available research, having instead developed piecemeal from improvements and clinician experience. Perhaps consequently, clinical practices quite reasonably vary considerably among clinicians within institutions, and even more across institutions and around the world. Insufficient knowledge is hardly limited to anesthetic management and extends to surgical practice and all other areas of medicine.
Even across major variations in practice, there is little convincing evidence for that one approach is preferable to another.1  Consider, for example, the limited supporting evidence for (or compelling evidence against) stress testing or tomographic angiography, volatile anesthetic toxicity in neonates, neuraxial versus general anesthesia, intravenous versus volatile anesthesia, supplemental oxygen for prevention of surgical site infection, and targeted temperature management for most any indication except neonatal hypoxia. Even less evidence supports more subtle practice differences such as amount and type of intravenous fluid, intraoperative tidal volume, and positive end-expiratory pressure.