New AANA Study Shows Surgical Death Rates Not Affected

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trg2002

Taken from the AANA website:

For Immediate Release: April 11, 2003


New Study Shows Surgical Death Rates Not Affected
by Type of Anesthesia Provider

Data reveals no significant differences in surgical mortality rates
when anesthesia is provided by nurse anesthetists
or anesthesiologists working individually or together.

PARK RIDGE, Illinois?Patients are just as safe receiving their anesthesia care from Certified Registered Nurse Anesthetists (CRNAs) or physician anesthesiologists working individually, or from CRNAs and anesthesiologists working in anesthesia care teams, according to a groundbreaking study published in the April 2003 AANA Journal.

The Institute of Medicine estimates that anesthesia care today is nearly 50 times safer than it was 20 years ago, with one anesthesia-related death per 200,000-300,000 cases. Despite this record of improvement, questions have remained about surgical patient safety related to types of anesthesia providers.

The study, titled "Surgical Mortality and Type of Anesthesia Provider," analyzed the effect of different types of anesthesia providers on the death rates of Medicare patients undergoing surgery. Researchers Michael Pine, MD, Kathleen Holt, PhD, and You-Bei Lou, PhD, studied 404,194 cases that took place from 1995-1997 in 22 states.

According to the study, surgical death rates were essentially the same whether anesthesiologists or nurse anesthetists provided the anesthesia individually or worked together in anesthesia care teams. Further, hospitals in which CRNAs were the only anesthesia providers had results similar to hospitals where anesthesiologists were involved in the anesthesia care.

Only cases with clear documentation of type of anesthesia provider were studied, and adjustments were made for differences in case mix, clinical risk factors, hospital characteristics, and geographic location. The types of surgical procedures included carotid endarterectomies, cholecystectomies, herniorrhaphies, mastectomies, hysterectomies, laminectomies, prostatectomies, and knee replacements.

"The results of this study are significant, particularly in this time of anesthesia provider shortages and rising healthcare costs," said Rodney C. Lester, CRNA, PhD, president of the 30,000-member American Association of Nurse Anesthetists (AANA). "It confirms what the AANA has been saying all along: Anesthesia today is safer than it has ever been, regardless of whether the anesthesia provider is a CRNA or an anesthesiologist.

"With the demand for surgical care and other procedures requiring anesthesia growing annually, and an insufficient number of qualified anesthesia providers to satisfy this demand, it is important that the current supply of CRNAs and anesthesiologists be used effectively," said Lester. "It should give patients great comfort to know that they are receiving the same high-quality anesthesia care whether it is provided by a CRNA or an anesthesiologist working individually or in a team."

Nurse anesthetists have been providing anesthesia care in the United States for more than 100 years. Today, CRNAs are the hands-on providers of approximately 65 percent of all U.S. anesthetics, and they are the primary anesthesia caregivers in the military, rural communities, and delivery rooms.

To read the study, visit the AANA Web site at www.aana.com and click on "Press Releases."


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About the American Association of Nurse Anesthetists
Founded in 1931 and located in Park Ridge, III., the AANA is the professional association for more than 30,000 CRNAs. As advanced practice nurses, CRNAs administer approximately 65 percent of the 26 million anesthetics delivered in the United States each year. CRNAs practice in every setting where anesthesia is available and are the sole anesthesia providers in more than two-thirds of all rural hospitals.


**** Interesting, but not that surprising. The cases studied seem to be standard bread and butter cases. I would not expect there to be much of a difference with these types of cases...

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Post #3

flawed study for several reasons:

1) it is retrospective - we need a prospective well balanced study
2) it only looks at mortality rates on mainly benign procedures - in which morbidity/length of stay etc would provide more information
3) "Medicare data do not distinguish between valid risk factors (ie, comorbid conditions) and inpatient complications, risk adjustment using Medicare data may fail to capture the true preoperative risk of death."

it also doesn't describe impact of pre-operative risk assessment, pre-operative medical management by anesthesia provider

the assumption that safety is determined by surgical death rate is insufficient...

but here is what really blows me away about this study which is kind of embarassing for the authors of that study: they were using predicted mortality rates based on old statistical analysis and didn't even compare actual mortality rates of the 400,000 cases they looked at.... what a waste of time, they could have done much better...

my 2 cents,
tenesma

PS here is link for those who want to read the study:
http://www.aana.com/press/2003/041103_pine.asp
 
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Almost reminds me of the drug reps leaving articles for us to read pre-highlighted with how this "Independant Study" shows their drug is superior to others. Gotta Love it.
 
Originally posted by meandragonbrett
Interesting that one of the authors is a MD.

yep, there's no monopoly on poor quality research.

On the other hand, how many of the remarkable advances in anesthesia that have happened in the last half-century have been attributable to CRNA's?
 
It confirms what the AANA has been saying all along: Anesthesia today is safer than it has ever been, regardless of whether the anesthesia provider is a CRNA or an anesthesiologist.

I don't think it's in debate that anesthesia is safer now than it ever has been. This study means nothing to me without also discussing morbidity as Tenesma already pointed out.
 
This debate is meaningless & so is the study, relative numbers of CRNA's & anethesiologists are & always will be driven by market forces, and there will alawys be a need for anesthesiologists who are not completely dispensable regardless of what meandragonbrett et al may think.

If they were do you think any administator in his right mind would pay 200-300G to employ one?
 
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