Anesthesia Care Transitions and Risk of Postoperative Complications

Joseph A. Hyder, J. Kyle Bohman, Daryl J Kor, Arun Subramanian, Edward A. Bittner, Bradly J. Narr, Robert R. Cima, Victor Manuel Montori

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: A patient undergoing surgery may receive anesthesia care from several anesthesia providers. The safety of anesthesia care transitions has not been evaluated. Using unconditional and conditional multivariable logistic regression models, we tested whether the number of attending anesthesiologists involved in an operation was associated with postoperative complications. METHODS: In a cohort of patients undergoing elective colorectal surgical in an academic tertiary care center with a stable anesthesia care team model participating in the American College of Surgeons National Surgical Quality Improvement Program, using unconditional and conditional multivariable logistic regression models, we tested adjusted associations between numbers of attending anesthesiologists and occurrence of death or a major complication (acute renal failure, bleeding that required a transfusion of 4 units or more of red blood cells within 72 hours after surgery, cardiac arrest requiring cardiopulmonary resuscitation, coma of 24 hours or longer, myocardial infarction, unplanned intubation, ventilator use for 48 hours or more, pneumonia, stroke, wound disruption, deep or organ-space surgical-site infection, superficial surgical-site infection, sepsis, septic shock, systemic inflammatory response syndrome). RESULTS: We identified 927 patients who underwent elective colectomy of comparable surgical intensity. In all, 71 (7.7%) patients had major nonfatal complications or death. One anesthesiologist provided care for 530 (57%) patients, 2 anesthesiologists for 287 (31%), and 3 or more for 110 (12%). The number of attending anesthesiologists was associated with increased odds of postoperative complication (unadjusted odds ratio [OR] = 1.52, 95% confidence interval [CI] 1.18-1.96, P = 0.0013; adjusted OR = 1.44, 95% CI 1.09-1.91, P = 0.0106). In sensitivity analyses, occurrence of a complication was significantly associated with the number of in-room providers, defined as anesthesia residents and nurse anesthetists (adjusted OR = 1.39, 95% CI 1.01-1.92, P = 0.0446) and for all anesthesia providers (adjusted OR = 1.58, 95%CI 1.20-2.08, P = 0.0012). Findings persisted across multiple, alternative adjustments, sensitivity analyses, and conditional logistic regression with matching on operative duration. CONCLUSIONS: In our study, care by additional attending anesthesiologists and in-room providers was independently associated with an increased odds of postoperative complications. These findings challenge the assumption that anesthesia transitions are care neutral and not contributory to surgical outcomes.

Original languageEnglish (US)
Pages (from-to)134-144
Number of pages11
JournalAnesthesia and Analgesia
Volume122
Issue number1
DOIs
StatePublished - Jan 1 2016

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Patient Transfer
Anesthesia
Logistic Models
Odds Ratio
Confidence Intervals
Surgical Wound Infection
Nurse Anesthetists
Systemic Inflammatory Response Syndrome
Colectomy
Cardiopulmonary Resuscitation
Mechanical Ventilators
Coma
Septic Shock
Quality Improvement
Heart Arrest
Acute Kidney Injury
Intubation
Tertiary Care Centers
Anesthesiologists
Sepsis

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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Anesthesia Care Transitions and Risk of Postoperative Complications. / Hyder, Joseph A.; Bohman, J. Kyle; Kor, Daryl J; Subramanian, Arun; Bittner, Edward A.; Narr, Bradly J.; Cima, Robert R.; Montori, Victor Manuel.

In: Anesthesia and Analgesia, Vol. 122, No. 1, 01.01.2016, p. 134-144.

Research output: Contribution to journalArticle

Hyder, JA, Bohman, JK, Kor, DJ, Subramanian, A, Bittner, EA, Narr, BJ, Cima, RR & Montori, VM 2016, 'Anesthesia Care Transitions and Risk of Postoperative Complications', Anesthesia and Analgesia, vol. 122, no. 1, pp. 134-144. https://doi.org/10.1213/ANE.0000000000000692
Hyder, Joseph A. ; Bohman, J. Kyle ; Kor, Daryl J ; Subramanian, Arun ; Bittner, Edward A. ; Narr, Bradly J. ; Cima, Robert R. ; Montori, Victor Manuel. / Anesthesia Care Transitions and Risk of Postoperative Complications. In: Anesthesia and Analgesia. 2016 ; Vol. 122, No. 1. pp. 134-144.
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N2 - BACKGROUND: A patient undergoing surgery may receive anesthesia care from several anesthesia providers. The safety of anesthesia care transitions has not been evaluated. Using unconditional and conditional multivariable logistic regression models, we tested whether the number of attending anesthesiologists involved in an operation was associated with postoperative complications. METHODS: In a cohort of patients undergoing elective colorectal surgical in an academic tertiary care center with a stable anesthesia care team model participating in the American College of Surgeons National Surgical Quality Improvement Program, using unconditional and conditional multivariable logistic regression models, we tested adjusted associations between numbers of attending anesthesiologists and occurrence of death or a major complication (acute renal failure, bleeding that required a transfusion of 4 units or more of red blood cells within 72 hours after surgery, cardiac arrest requiring cardiopulmonary resuscitation, coma of 24 hours or longer, myocardial infarction, unplanned intubation, ventilator use for 48 hours or more, pneumonia, stroke, wound disruption, deep or organ-space surgical-site infection, superficial surgical-site infection, sepsis, septic shock, systemic inflammatory response syndrome). RESULTS: We identified 927 patients who underwent elective colectomy of comparable surgical intensity. In all, 71 (7.7%) patients had major nonfatal complications or death. One anesthesiologist provided care for 530 (57%) patients, 2 anesthesiologists for 287 (31%), and 3 or more for 110 (12%). The number of attending anesthesiologists was associated with increased odds of postoperative complication (unadjusted odds ratio [OR] = 1.52, 95% confidence interval [CI] 1.18-1.96, P = 0.0013; adjusted OR = 1.44, 95% CI 1.09-1.91, P = 0.0106). In sensitivity analyses, occurrence of a complication was significantly associated with the number of in-room providers, defined as anesthesia residents and nurse anesthetists (adjusted OR = 1.39, 95% CI 1.01-1.92, P = 0.0446) and for all anesthesia providers (adjusted OR = 1.58, 95%CI 1.20-2.08, P = 0.0012). Findings persisted across multiple, alternative adjustments, sensitivity analyses, and conditional logistic regression with matching on operative duration. CONCLUSIONS: In our study, care by additional attending anesthesiologists and in-room providers was independently associated with an increased odds of postoperative complications. These findings challenge the assumption that anesthesia transitions are care neutral and not contributory to surgical outcomes.

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