From the Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.
Department of Anesthesiology, University Medical Center Goettingen, Goettingen, Germany.
Anesth Analg. 2021 Mar 1;132(3):866-877. doi: 10.1213/ANE.0000000000005318.
Anesthesiologists typically care for patients having a broad range of procedures. Outcomes might be improved when care is provided by caregivers experienced in particular types of surgery. We tested the hypothesis that intraoperative care provided by pairs of anesthesia caregivers having significant experience with a particular type of surgery reduces a composite of in-hospital death and 6 serious complications, including bleeding, cardiac, gastrointestinal, infectious, respiratory, and urinary complications, compared to care provided by pairs of anesthesia caregivers with less experience.
We included patients having surgery lasting at least 30 minutes. Using cluster analysis, attending anesthesiologists, and Certified Registered Nurse Anesthetists (CRNAs) were identified as experienced or inexperienced caregivers for each type of surgery at the case level. We then compared surgeries for which anesthesia was provided by a pair of experienced caregivers versus a pair of inexperienced caregivers on our composite outcome. We estimated the average relative effect (ie, the exponentiated average log odds ratio) of receiving anesthesia from an experienced versus inexperienced caregiver pair across the 7 components of the composite outcome using a generalized estimating equation (GEE) model to adjust for between-component correlation and with inverse propensity score weighing to adjust for potential confounding from a host of variables.
A total of 8968 patients who received anesthesia care by an experienced pair were compared with 25,361 patients who received care from an inexperienced pair, adjusting for potential confounding. The incidence of composite complications (ie, any component event) was 7.6% (677/8968) for experienced pairs and 12% (2976/25,361) for inexperienced pairs (P < .001). Care by experienced pairs of caregivers was associated with lower odds of the composite outcome with an estimated average relative effect odds ratio across the individual components of 0.61 (95% confidence interval [CI], 0.54-0.71), P < .001. Among the 7 components of the primary outcome, experienced pairs of providers had significantly lower estimated odds of bleeding, infection, and mortality.
Anesthesia care by experienced pairs was associated with fewer bleeding complications, fewer infections, shorter hospitalization, and reduced in-hospital mortality.
麻醉师通常负责各种手术的患者。当护理人员在特定类型的手术方面具有丰富经验时，护理质量可能会提高。我们假设，与经验较少的麻醉护理人员配对相比，在特定类型手术方面具有丰富经验的一对麻醉护理人员提供的术中护理可以减少住院期间死亡和 6 种严重并发症（包括出血、心脏、胃肠道、感染、呼吸和泌尿系统并发症）的复合发生率。
我们纳入了手术持续时间至少 30 分钟的患者。使用聚类分析，在病例水平上将主治麻醉师和注册护士麻醉师（CRNA）确定为每种手术的有经验或无经验护理人员。然后，我们比较了由一对有经验的护理人员与一对无经验的护理人员提供麻醉的手术在我们的复合结果上的差异。我们使用广义估计方程（GEE）模型估计接受有经验的护理人员与无经验的护理人员提供的麻醉的平均相对效果（即平均对数优势比的指数），以调整各组成部分之间的相关性，并使用逆概率评分加权来调整各种变量的潜在混杂因素。
共有 8968 名接受有经验护理人员麻醉的患者与 25361 名接受无经验护理人员麻醉的患者进行了比较，调整了潜在混杂因素。有经验的护理人员组复合并发症（即任何一个组成部分的事件）的发生率为 7.6%（677/8968），无经验的护理人员组为 12%（2976/25361）（P <.001）。有经验的护理人员配对提供的护理与复合结果的可能性较低相关，各个组成部分的估计平均相对效果比值为 0.61（95%置信区间[CI]，0.54-0.71），P <.001。在主要结果的 7 个组成部分中，有经验的护理人员配对提供者发生出血、感染和死亡的可能性显著降低。
经验丰富的护理人员配对提供的麻醉护理与出血并发症减少、感染减少、住院时间缩短和住院期间死亡率降低有关。
