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Anesthesiology Sep 2018Teamwork is now recognized as important for safe, high-quality perioperative care. The relationship in each surgeon-anesthesiologist dyad is perhaps the most critical... (Review)
Review
Teamwork is now recognized as important for safe, high-quality perioperative care. The relationship in each surgeon-anesthesiologist dyad is perhaps the most critical element of overall team performance. A well-functioning relationship is conducive to safe, effective care. A dysfunctional relationship can promote unsafe conditions and contribute to an adverse outcome. Yet, there is little research about this relationship, about what works well or not well, what can be done to optimize it. This article explores functional and dysfunctional aspects of the relationship, identifies some negative stereotypes each profession has of the other and calls for research to better characterize and understand how to improve working relationships. Suggestions are given for what an ideal relationship might be and actions that surgeons and anesthesiologists can take to improve how they work together. The goal is safer care for patients, and more joy and meaning in work for surgeons and anesthesiologists.
Topics: Anesthesiologists; Attitude of Health Personnel; Humans; Patient Care Team; Patient Safety; Physician's Role; Surgeons
PubMed: 30045093
DOI: 10.1097/ALN.0000000000002324 -
JAMA Surgery Sep 2022Recent studies have investigated the effect of overlapping surgeon responsibilities or nurse to patient staffing ratios on patient outcomes, but the association of...
IMPORTANCE
Recent studies have investigated the effect of overlapping surgeon responsibilities or nurse to patient staffing ratios on patient outcomes, but the association of overlapping anesthesiologist responsibilities with patient outcomes remains unexplored to our knowledge.
OBJECTIVE
To examine the association between different levels of anesthesiologist staffing ratios and surgical patient morbidity and mortality.
DESIGN, SETTING, AND PARTICIPANTS
A retrospective, matched cohort study consisting of major noncardiac inpatient surgical procedures performed from January 1, 2010, to October 31, 2017, was conducted in 23 US academic and private hospitals. A total of 866 453 adult patients (aged ≥18 years) undergoing major inpatient surgery within the Multicenter Perioperative Outcomes Group electronic health record registry were included. Anesthesiologist sign-in and sign-out times were used to calculate a continuous time-weighted average staffing ratio variable for each operation. Propensity score-matching methods were applied to create balanced sample groups with respect to patient-, operative-, and hospital-level confounders and resulted in 4 groups based on anesthesiologist staffing ratio. Groups consisted of patients receiving care from an anesthesiologist covering 1 operation (group 1), more than 1 to no more than 2 overlapping operations (group 1-2), more than 2 to no more than 3 overlapping operations (group 2-3), and more than 3 to no more than 4 overlapping operations (group 3-4). Data analysis was performed from October 2019 to October 2021.
EXPOSURE
Undergoing a major inpatient surgical operation that involved an anesthesiologist providing care for up to 4 overlapping operations.
MAIN OUTCOMES AND MEASURES
The primary composite outcome was 30-day mortality and 6 major surgical morbidities (cardiac, respiratory, gastrointestinal, urinary, bleeding, and infectious complications) derived from International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision discharge diagnosis codes.
RESULTS
In all, 578 815 adult patients (mean [SD] age, 55.7 [16.2] years; 55.1% female) were analyzed. After matching operations according to anesthesiologist staffing ratio, 48 555 patients were in group 1; 247 057, group 1-2; 216 193, group 2-3; and 67 010, group 3-4. Increasing anesthesiologist coverage responsibilities was associated with an increase in risk-adjusted surgical patient morbidity and mortality. Compared with patients in group 1-2, those in group 2-3 had a 4% relative increase in risk-adjusted mortality and morbidity (5.06% vs 5.25%; adjusted odds ratio [AOR], 1.04; 95% CI, 1.01-1.08; P = .02) and those in group 3-4 had a 14% increase in risk-adjusted mortality and morbidity (5.06% vs 5.75%; AOR, 1.15; 95% CI, 1.09-1.21; P < .001).
CONCLUSIONS AND RELEVANCE
This study's findings suggest that increasing overlapping coverage by anesthesiologists is associated with increased surgical patient morbidity and mortality. Therefore, the potential effects of staffing ratios in perioperative team models should be considered in clinical coverage efforts.
Topics: Adolescent; Adult; Anesthesiologists; Cohort Studies; Female; Humans; Male; Middle Aged; Morbidity; Postoperative Complications; Retrospective Studies; Workforce
PubMed: 35857304
DOI: 10.1001/jamasurg.2022.2804 -
Journal of Anesthesia Apr 2022This narrative review intends to provide the anesthesiologist with the basic knowledge of the Bayesian concepts and should be considered as a tutorial for... (Review)
Review
This narrative review intends to provide the anesthesiologist with the basic knowledge of the Bayesian concepts and should be considered as a tutorial for anesthesiologists in the concept of Bayesian statistics. The Bayesian approach represents the mathematical formulation of the idea that we can update our initial belief about data with the evidence obtained from any kind of acquired data. It provides a theoretical framework and a statistical method to use pre-existing information within the context of new evidence. Several authors have described the Bayesian approach as capable of dealing with uncertainty in medical decision-making. This review describes the Bayes theorem and how it is used in clinical studies in anesthesia and critical care. It starts with a general introduction to the theorem and its related concepts of prior and posterior probabilities. Second, there is an explanation of the basic concepts of the Bayesian statistical inference. Last, a summary of the applicability of some of the Bayesian statistics in current literature is provided, such as Bayesian analysis of clinical trials and PKPD modeling.
Topics: Anesthesia; Anesthesiologists; Anesthesiology; Bayes Theorem; Humans
PubMed: 35147768
DOI: 10.1007/s00540-022-03044-9 -
Brazilian Journal of Anesthesiology... 2015Anesthesia is still a major concern for patients, although the anesthetic complications have decreased significantly. Additionally, the role assigned to the...
BACKGROUND AND OBJECTIVES
Anesthesia is still a major concern for patients, although the anesthetic complications have decreased significantly. Additionally, the role assigned to the anesthesiologist remains inaccurate. The aim of this study was to evaluate the concerns with anesthesia and assess the patient's knowledge about the anesthesiologist's duties.
METHODS
Prospective study conducted over three months with patients in the preoperative anesthetic visit in a university hospital. Demographic information about the level of education and prior anesthesia was obtained. The knowledge of patients regarding the anesthesiologists' education was evaluated. Patients' concerns and anesthesiologist and surgeon responsibilities were classified with a 5-point scale. The analysis was performed with SPSS 21, and p<0.05 was considered statistically significant.
RESULTS
We included 204 patients, and 135 (66.2%) recognized the anesthesiologist as a specialist physician. Not waking up after surgery and postoperative infection were the main concerns compared to all others (p<0.05). Women expressed more concern than men about not waking up after surgery, nausea and postoperative vomiting, medical problems, and waking up during surgery (p<0.05). Ensure that patients do not wake up during surgery was the anesthesiologist task most recognized, compared to all other (p<0.05). The surgeon was more recognized (p<0.05) than the anesthesiologist in post-operative, antibiotics administration, and blood transfusions pain management.
CONCLUSIONS
Patients need to be informed about the current safety of anesthesia and the anesthesiologist's functions. The patient involvement will demystify some fears and reassure the confidence in the health system.
Topics: Anesthesia; Anesthesiologists; Female; Humans; Male; Middle Aged; Patient Safety; Perception; Physician-Patient Relations; Prospective Studies
PubMed: 26614148
DOI: 10.1016/j.bjane.2014.05.014 -
JAMA Surgery May 2021Intraoperative anesthesiology care is crucial to high-quality surgical care. The clinical expertise and experience of anesthesiologists may decrease the risk of adverse...
IMPORTANCE
Intraoperative anesthesiology care is crucial to high-quality surgical care. The clinical expertise and experience of anesthesiologists may decrease the risk of adverse outcomes.
OBJECTIVE
To examine the association between anesthesiologist volume and short-term postoperative outcomes for complex gastrointestinal (GI) cancer surgery.
DESIGN, SETTING, AND PARTICIPANTS
This population-based cohort study used administrative health care data sets from various data sources in Ontario, Canada. Adult patients who underwent esophagectomy, pancreatectomy, or hepatectomy for GI cancer from January 1, 2007, to December 31, 2018, were eligible. Patients with an invalid identification number, a duplicate surgery record, and missing primary anesthesiologist information were excluded.
EXPOSURES
Primary anesthesiologist volume was defined as the annual number of procedures of interest (esophagectomy, pancreatectomy, and hepatectomy) supported by that anesthesiologist in the 2 years before the index surgery. Volume was dichotomized into low-volume and high-volume categories, with 75th percentile or 6 or more procedures per year selected as the cutoff point.
MAIN OUTCOME AND MEASURES
The primary outcome was a composite of 90-day major morbidity (with a Clavien-Dindo classification grade 3-5) and readmission. Secondary outcomes were individual components of the primary outcome. The association between exposure and outcomes was examined using multivariable logistic regression models, accounting for potential confounders.
RESULTS
Of the 8096 patients included, 5369 were men (66.3%) and the median (interquartile range [IQR]) age was 65 (57-72) years. Operations were supported by 842 anesthesiologists and performed by 186 surgeons, and the median (IQR) anesthesiologist volume was 3 (1.5-6) procedures per year. A total of 2166 patients (26.7%) received care from high-volume anesthesiologists. Primary outcome occurred in 36.3% of patients in the high-volume group and 45.7% of patients in the low-volume group. After adjustment, care by high-volume anesthesiologists was independently associated with lower odds of the primary outcome (adjusted odds ratio [aOR], 0.85; 95% CI, 0.76-0.94), major morbidity (aOR, 0.83; 95% CI, 0.75-0.91), unplanned intensive care unit admission (aOR, 0.84; 95% CI, 0.76-0.94), but not readmission (aOR, 0.87; 95% CI, 0.73-1.05) or mortality (aOR, 1.05; 95% CI, 0.84-1.31). E-values analysis indicated that an unmeasured variable would unlikely substantively change the observed risk estimates.
CONCLUSIONS AND RELEVANCE
This study found that, among adults who underwent complex gastrointestinal cancer surgery, those who received care from high-volume anesthesiologists had a lower risk of adverse postoperative outcomes compared with those who received care from low-volume anesthesiologists. These findings support organizing perioperative care to increase anesthesiologist volume to optimize patient outcomes.
Topics: Aged; Anesthesiologists; Clinical Competence; Critical Care; Databases, Factual; Digestive System Neoplasms; Esophagectomy; Female; Hepatectomy; Humans; Male; Middle Aged; Ontario; Pancreatectomy; Patient Readmission; Postoperative Complications; Retrospective Studies; Time Factors; Treatment Outcome
PubMed: 33729435
DOI: 10.1001/jamasurg.2021.0135 -
Anaesthesiology Intensive Therapy 2023Heart rate variability (HRV) is a measure that shows the variation in time between consecutive heartbeats - a physiological phenomenon controlled by the autonomic... (Review)
Review
Heart rate variability (HRV) is a measure that shows the variation in time between consecutive heartbeats - a physiological phenomenon controlled by the autonomic nervous system. Over the years the analysis of this parameter has been used in many fields of medicine, including anaesthesiology, for scientific and research purposes. We carried out a review of the available literature on the applicability of HRV assessment in anaesthesiology. Several potential applications of HRV in clinical anaesthesia have been identified and proven feasible. As a non-invasive and relatively easy method to gauge the autonomic nervous system, HRV analysis can provide the anaesthesiologist with additional datapoints, potentially useful in assessing efficacy of a blockade and adequacy of analgesia, and in predicting adverse events. However, interpretation of HRV and generalizability of research findings can be problematic due to the multiplicity of factors that influence this parameter and bias in methods introduced by the researchers.
Topics: Humans; Anesthesiology; Heart Rate; Anesthesiologists; Anesthesia; Analgesia
PubMed: 37306266
DOI: 10.5114/ait.2023.126309 -
Anesthesiology Jul 2021
Topics: Anesthesia; Anesthesiologists; Anesthesiology; Humans
PubMed: 33857296
DOI: 10.1097/ALN.0000000000003785 -
Anesthesiology Jul 2021
Topics: Anesthesia; Anesthesiologists; Anesthesiology; Humans
PubMed: 33857286
DOI: 10.1097/ALN.0000000000003784 -
Anesthesiology Mar 2019The methodology used during the development of American Society of Anesthesiologists evidence-based practice parameters, from conceptualization through final adoption of... (Review)
Review
The methodology used during the development of American Society of Anesthesiologists evidence-based practice parameters, from conceptualization through final adoption of the documents, is described. Features of the methodology include the literature search, review and analysis, survey development and application, and consolidation of the full body of evidence used for preparing clinical practice recommendations. Anticipated risks of bias, validation of the process, and the importance of the documents for clinical use are discussed.
Topics: Anesthesiologists; Humans; Practice Guidelines as Topic; Societies, Medical; United States
PubMed: 30724774
DOI: 10.1097/ALN.0000000000002551 -
Advances in Anesthesia Dec 2022A shortage of inpatient beds and nurses during the coronavirus disease 2019 pandemic has lent priority to safe same-day discharge after surgery. The minimally invasive... (Review)
Review
A shortage of inpatient beds and nurses during the coronavirus disease 2019 pandemic has lent priority to safe same-day discharge after surgery. The minimally invasive nature of robotic surgery has allowed an increasing number of procedures to be done on an outpatient basis. Anesthetic management should be designed to complement the technical advantages of robotic surgery in facilitating early discharge.
Topics: Humans; Robotic Surgical Procedures; Anesthesiologists; Outpatients; COVID-19; Robotics
PubMed: 36333045
DOI: 10.1016/j.aan.2022.06.001