Anesthesia Care Team Composition and Surgical Outcomes.

Area of Science:

• Anesthesiology
• Health Services Research
• Healthcare Policy

Background:

• Anesthesia care in the US involves physician anesthesiologists supervising nonphysician providers like nurse anesthetists and anesthesiologist assistants.
• Nurse anesthetists practice nationwide, while anesthesiologist assistants are limited to 16 states, impacting care team composition.
• Understanding the impact of different anesthesia care team structures is crucial for informing policy decisions.

Purpose of the Study:

• To investigate if anesthesia care team composition (physician anesthesiologist + nurse anesthetist vs. physician anesthesiologist + anesthesiologist assistant) affects perioperative outcomes.
• To provide evidence for potential policy changes regarding the expanded use of anesthesiologist assistants.

Main Methods:

• Retrospective analysis of national claims data from 443,098 publicly insured elderly patients (ages 65-89) undergoing inpatient surgery (2004-2011).
• Utilized instrumental variables, a quasirandomization technique, to estimate differences in inpatient mortality, spending, and length of stay.
• Compared outcomes between care teams supervised by an anesthesiologist with an anesthesiologist assistant versus those with a nurse anesthetist.

Main Results:

• Adjusted inpatient mortality was 1.6% for teams with anesthesiologist assistants versus 1.7% for teams with nurse anesthetists (P = 0.47).
• Teams with anesthesiologist assistants showed non-statistically significant decreases in length of stay (-0.009 days, P = 0.89) and medical spending (-$56, P = 0.70).

Conclusions:

• The specific composition of the anesthesia care team, whether nurse anesthetists or anesthesiologist assistants, was not associated with significant differences in mortality.
• No significant variations in length of stay or inpatient spending were observed based on the nonphysician provider within the anesthesia care team.
• Findings suggest that anesthesia care team composition does not impact key perioperative outcomes, potentially supporting broader utilization of anesthesiologist assistants.