Higher overlapping of duties of anesthesiologist may increase mortality and morbidity in surgical patients

There is a correlation between suboptimal patient outcomes and overlapping duties across several medical professions. In anesthesiology, where this practise is common, overlapping roles arise in models where an anesthesiologist supervises certified registered nurse anaesthetists (CRNAs), anaesthesia assistants, or anesthesiology residents. However, this has not been well investigated in this field. The purpose of this retrospective cohort research was to determine whether patient significant morbidity or death and different anesthesiology staffing ratios were related. Data from 23 hospitals in 18 U.S. states were purchased via the Multicenter Perioperative Outcomes Group (MPOG) database between January 1, 2010, and October 31, 2017. Operations were omitted if care was given directly by the staff anesthesiologist; operations were included if an anesthesiologist was overseeing rooms directly under the care of CRNAs or ones with less than 25% resident participation. Groups were formed based on the number of operations that the staff anesthesiologist was covering; these groups were created using propensity-score matching (group 1: staffing ratio of 1; group 1-2: staffing ratio between 1 and 2; group 2-3: staffing ratio between 2 and 3; group 3-4: staffing ratio between 3 and 4). The main outcome was a composite of six major surgical co-morbidities (gastrointestinal, respiratory, urinary, bleeding, and infectious) and 30-day death. Patients in groups 2-3 and 3-4 showed a 4% and 14% relative increase in risk of serious morbidity or death, respectively, compared to groups 1-2 and group 3-4, with adjusted odds ratios (AORs) of 1.04 [95% CI: 1.01-1.18] and p<0.001, respectively. Furthermore, compared to groups 2-3, group 3-4 had a substantially higher risk of morbidity or death (AOR: 1.10 [95% CI: 1.04-1.16]; p = 0.001). Overall, the risk of 30-day mortality and surgical patient morbidity rose with an increase in overlapping anesthesiologist coverage. These findings have important implications considering the millions of surgical operations done annually, even with slight increases in risk. The results were statistically significant. The rigorous exclusion criteria used in this study, which limited resident involvement in an operating room to less than 25%, is one of its limitations. To better understand these effects, more research on the effects of supervising multiple residents should be conducted.

Reference-

Burns ML, Saager L, Cassidy RB, Mentz G, Mashour GA, Kheterpal S. Association of Anesthesiologist Staffing Ratio With Surgical Patient Morbidity and Mortality. JAMA Surg. 2022;157(9):807–815. doi:10.1001/jamasurg.2022.2804