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A recent large study suggests anesthesiologists who split their time over multiple operating suites are linked to higher incidence of patient complications and death.

“Overlapping” is the term used when an anesthesiologist induces the next surgical patient in an operating room (OR) while a previous patient is still in surgery. Overlapping is useful when qualified staff are limited, and the procedure also increases productivity and profit.  But—at what cost to the surgical patient?

 A recent study published in JAMA Surgery investigated whether overlapping increases the risk of injury or death for surgery patients.  Study authors reviewed electronic medical data for 578,815 adults from 23 different institutions between January 2010 to October 2017 to consider how overlapping impacts the health of those undergoing surgery.  The data was gleaned from the Multicenter Perioperative Outcomes Group electronic registry.  Review of the data produced four distinct groups; those with surgeries being overseen by one anesthesiologist, no more than two anesthesiologists, no more than three providers, and no more than four anesthesiologists.

For clarity, the swapping out of anesthesiologists does not suggest there was no anesthesia professional attending during these surgeries.  Other qualified attendants may include a certified registered nurse anesthetist (CRNA) or an anesthesiology resident in addition to an anesthesiologist.  While a patient undergoing surgery may believe the anesthesiologist who assists them with sedation at the outset will be present throughout their surgery, it is not uncommon for the anesthesiologist to supervise clinicians in several ORs, rather than remaining at bedside.

Study authors were looking at death rates for surgery patients at 30-days out and also at major surgical complications including infection, urinary bleeding, cardiac, gastrointestinal, and respiratory complications.

Overall, the study found the risk of patient death or serious complication increased with the number of ORs being supervised by the assigned anesthesiologist. Patients treated by an anesthesiologist covering no more than three ORs had an increased risk of four percent compared to patients being cared for by an anesthesiologist covering only one or two ORs.  Patients with providers covering four ORs suffered increased risk of 14 percent.

Dr. Sachin Kheterpal, a professor of Anesthesiology at Michigan Medicine notes, “Cost reduction efforts often target high fixed-cost anesthesiology services, assuming that increased clinical responsibilities are noninferior to lower patient to anesthesiologist staffing ratios. Understanding the potential association with the quality of patient care is necessary to inform clinical care staffing decisions.”

Added Dr. Kheterpal, “We now have evidence to support the idea that in some situations, increasing overlapping responsibilities may have some potential downsides that balance the advantages of potential cost savings and access to care.”

Overlapping anesthesiologists may net more money for the facility and providers—but can result in increased risk of death and disability for patients.  When considering surgery, healthcare consumers can do themselves a favor by inquiring about their anesthesia care as well as surgical care in the OR where their health and lives are dependent on the attention of their healthcare providers.

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