Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Ann Surg. 2023 Oct 1;278(4):e820-e826. doi: 10.1097/SLA.0000000000005811. Epub 2023 Jan 24.
Examine between-hospital and between-anesthesiologist variation in anesthesiology provider-volume (PV) and delivery of high-volume anesthesiology care.
Better outcomes for anesthesiologists with higher PV of complex gastrointestinal cancer surgery have been reported. The factors linking anesthesiology practice and organization to volume are unknown.
We identified patients undergoing elective esophagectomy, hepatectomy, and pancreatectomy using linked administrative health data sets (2007-2018). Anesthesiology PV was the annual number of procedures done by the primary anesthesiologist in the 2 years before the index surgery. High-volume anesthesiology was PV>6 procedures/year. Funnel plots to described variation in anesthesiology PV and delivery of high-volume care. Hierarchical regression models examined between-anesthesiologist and between-hospital variation in delivery of high-volume care use with variance partition coefficients (VPCs) and median odds ratios (MORs).
Among 7893 patients cared for at 17 hospitals, funnel plots showed variation in anesthesiology PV (median ranging from 1.5, interquartile range: 1-2 to 11.5, interquartile range: 8-16) and delivery of HV care (ranging from 0% to 87%) across hospitals. After adjustment, 32% (VPC 0.32) and 16% (VPC: 0.16) of the variation were attributable to between-anesthesiologist and between-hospital differences, respectively. This translated to an anesthesiologist MOR of 4.81 (95% CI, 3.27-10.3) and hospital MOR of 3.04 (95% CI, 2.14-7.77).
Substantial variation in anesthesiology PV and delivery of high-volume anesthesiology care existed across hospitals. The anesthesiologist and the hospital were key determinants of the variation in high-volume anesthesiology care delivery. This suggests that targeting anesthesiology structures of care could reduce variation and improve delivery of high-volume anesthesiology care.
研究麻醉医师数量（PV）和大容量麻醉护理提供方面的医院间和麻醉医师间差异。
已有报道称，接受高容量复杂胃肠癌手术的麻醉医师的预后更好。将麻醉实践和组织与数量联系起来的因素尚不清楚。
我们使用链接的行政健康数据集（2007-2018 年）确定了接受择期食管切除术、肝切除术和胰切除术的患者。麻醉医师 PV 是索引手术前 2 年内主要麻醉医师每年完成的手术数量。大容量麻醉学是指每年进行的手术次数>6 次。使用漏斗图描述麻醉学 PV 和大容量护理提供方面的差异。分层回归模型使用方差分解系数（VPC）和中位数优势比（MOR）检查高容量护理使用的麻醉医师间和医院间差异。
在 17 家医院接受治疗的 7893 名患者中，漏斗图显示了麻醉学 PV（中位数范围从 1.5，四分位距：1-2 到 11.5，四分位距：8-16）和 HV 护理提供（范围从 0%到 87%）方面的医院间差异。调整后，32%（VPC 0.32）和 16%（VPC：0.16）的差异归因于麻醉医师间和医院间的差异。这转化为麻醉师的优势比为 4.81（95%CI，3.27-10.3）和医院的优势比为 3.04（95%CI，2.14-7.77）。
医院间在麻醉学 PV 和大容量麻醉护理提供方面存在大量差异。麻醉师和医院是大容量麻醉护理提供差异的关键决定因素。这表明针对麻醉护理结构进行干预可能会减少差异并改善大容量麻醉护理的提供。
