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Published on: August 25, 2022
Labor Cost Variation and Clinical Outcomes Across Anesthesiologist-Led Staffing Models for Atrial Fibrillation
Serena S Dasani1, Laura Mazuera2, Rosemary Kelley2
1Department of Anesthesiology, Critical Care, and Pain Medicine, UT Health Houston, Houston, TX.
Objectives:
Electrophysiology (EP) laboratories are a rapidly expanding environment for anesthesiologist-led care as atrial fibrillation (AF) ablation volumes increase. As institutions scale procedural capacity under workforce constraints, staffing configuration has become an important operational consideration. This study aims to evaluate clinical outcomes and labor cost variation across anesthesiologist-led staffing models for AF ablation procedures.
Design:
Retrospective cohort study.
Setting:
Two academic medical centers.
Participants:
Adults undergoing AF ablation under general anesthesia between 2015 and 2023.
Interventions:
Patients were stratified by anesthesia care team model: Solo (1 attending anesthesiologist), Supervised (1 attending supervising up to 3 certified registered nurse anesthetists), and Scholar (1 attending supervising up to 2 trainees). Multivariable regression evaluated associations between staffing models and outcomes. A staffing cost model estimated personnel labor costs across care team configurations, with sensitivity analyses across procedure durations.
Measurements And Main Results:
The primary outcome was hospital length of stay (LOS) in hours. Secondary outcomes included death within 24 hours, postoperative vasoactive medication use, reintubation, and pericardial tamponade. Among 5,632 patients, 31.1% received Solo care, 57.0% Supervised care, and 11.9% Scholar care. Adjusted analyses demonstrated statistically significant but modest differences in LOS across staffing models. After multivariable adjustment, the anesthesia care team model was not independently associated with postoperative vasoactive medication use. Mortality, reintubation, and tamponade rates were low across groups. Modeled annual labor cost variation across models ranged from $29,176.92 to $169,632.23.
Conclusions:
Anesthesiologist-led staffing configurations were associated with comparable short-term outcomes for AF ablation procedures. Staffing structure produced measurable operational cost variation at typical volumes; this provides data to inform anesthesia workforce planning in expanding EP services.
