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Anaesthetists have little affect on cardiac surgery mortality

Anaesthetists do not significantly affect mortality after cardiac surgery, outcomes being primarily determined by patient risk, with moderate variation between surgeons, according to a study published recently in Anaesthesia.1

Authors representing the Association of Cardiothoracic Anaesthetists (ACTA) studied the effect of the anaesthetist on mortality by analysing data collected prospectively over 10 years of consecutive cardiac surgical cases from 10 UK centres. Casemix-adjusted outcomes were analysed in models that included random-effects for centre, surgeon and anaesthetist. All cardiac surgical operations for which the EuroSCORE model is appropriate were included, and the primary outcome was in-hospital death up to three months postoperatively.

A total of 110,769 cardiac surgical procedures conducted between April 2002 and March 2012 were studied, which included 127 consultant surgeons and 190 consultant anaesthetists. The overwhelming factor associated with outcome was patient risk, accounting for 95.75% of the variation for in-hospital mortality. The impact of the surgeon was moderate (intra-class correlation coefficient 4.00% for mortality), and the impact of the anaesthetist was negligible (0.25%). There was no significant effect of anaesthetist volume above 10 cases per year.

These findings do not support public disclosure of cardiac anaesthetists’ results, but substantially validate current UK cardiac anaesthetic training and practice, say the authors. They call for further research to establish the potential effects of very low anaesthetic caseloads and the effect of cardiac anaesthetists on patient morbidity.

In an accompanying editorial, Dr R Peter Alston (Royal Infirmary of Edinburgh) praises the study for providing “convincing evidence that the variation in anaesthetist practice contributes little, if anything, to the mortality associated with cardiac surgery”. However, he also echoes the authors’ own sentiment by urging the ACTA to “move on to examine whether cardiac anaesthetists harm their patients, by measuring other outcomes from cardiac surgery that are important to patients and, if so, use these outcomes to measure their performance.”

References

1. Papachristofi O, Sharples LD, Mackay JH, Nashef SAM, Fletcher SN, Klein AA. The contribution of the anaesthetist to risk-adjusted mortality after cardiac surgery. Anaesthesia 2015. http://dx.doi.org/10.1111/anae.13291

Published on: November 24, 2015

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  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association
 

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