Um...this study is absolute GARBAGE and their conclusions are meaningless. Did you guys read the abstract that was posted?
Everywhere across the country anesthesiologists are called when a gastroenterologist encounters a patient who is going to be difficult to sedate with only midazolam and fentanyl. Naturally the patients who are more difficult to sedate and who anesthesia is involved with will have comorbidities (history of MI, COPD, obesity, etc.) which predispose them to a multitude of postoperative complications, both anesthesia and gastroenterology related.
So, the authors decide to try to control for this. They chose to adjust their patients based on the Charlson comorbidity score. Do you guys actually know what that is? Neither did I, but I looked it up. This is an index that was published in 1987 as a way to generate a score for a patient based on their comorbidities, with each comorbidity having a certain number of points associated with it. This cumulative total was then used to predict 10-year mortality.
Curious to know what comorbidities are included in the index and their relative weights? Here is a link:
http://touchcalc.com/calculators/cci_js
What the geniuses who published this study essentially said was a patient who has a history of MI and COPD has an EQUAL RISK of having postoperative complications as a patient with diabetic retinopathy. Or a patient with CHF, carotid stenosis, and MI had an EQUAL RISK of postoperative complications as a patient who carries a diagnosis of leukemia. And let's not even get into AIDS...if you have a chart diagnosis of AIDS then you're equivalent to someone with COPD, MI, CHF, COPD, DM, and dementia. Let's also note that MORBID OBESITY, one of the most COMMON comorbidities that anesthesiologists deal with in these out-of-OR cases and one of the biggest causes of postoperative complications is nowhere to be seen on this index, meaning all the anesthesia cases could have involved sedating patients with BMIs of 60.
My point is that it's MEANINGLESS to compare anesthesia versus non-anesthesia cases without first controlling for the things that actual predict postoperative complication, which is something that these authors failed miserably at.
And I've said it before and I'll say it again -- everyone needs to be a little more skeptical whenever you read a study. I've noticed a tendency to just accept conclusions at face value just because they appear in Pubmed or in a journal. Maybe my medical school trained us to be too skeptical of data and to critically analyze regardless of the source, but I'm glad they did so I can promptly disregard studies like this.