Li Gen, Freundlich Robert E, Rice Mark J, Dunworth Brent A, Sandberg Warren S, Higgins Michael S, Wanderer Jonathan P
Department of Anesthesiology, Vanderbilt University Medical Center, United States.
Department of Anesthesiology, Department of Biomedical Informatics, Vanderbilt University Medical Center, United States.
J Clin Anesth. 2024 Jun;94:111413. doi: 10.1016/j.jclinane.2024.111413. Epub 2024 Feb 15.
In 2018, the American Society of Anesthesiologists stated that student registered nurse anesthetists (SRNAs) "are not yet fully qualified anesthesia personnel." It remains unclear, however, whether postprocedural outcomes are affected by SRNAs providing anesthesia care under the medical direction of anesthesiologists, as compared with medically directed anesthesiology fellows or residents, or certified registered nurse anesthetists (CRNAs). We therefore aimed to examine whether medically directed SRNAs serving as in-room anesthesia providers impact surgical outcomes.
Retrospective, matched-cohort analysis.
Adult patients (≥18 years old) undergoing inpatient surgery between 2000 and 2017 at a tertiary academic medical center.
15,365 patients exclusively cared for by medically directed SRNAs were matched to 15,365 cared for by medically directed CRNAs, anesthesiology residents, and/or fellows.
None.
The primary composite outcome was postoperative occurrence of in-hospital mortality and six categories of major morbidities (infectious, bleeding, serious cardiac, gastrointestinal, respiratory, and urinary complications). In-hospital mortality was analyzed as the secondary outcome.
In all, 30,730 cases were matched using propensity score matching to control for potential confounding. The primary outcome was identified in 2295 (7.5%) cases (7.5% with exclusive medically directed SRNAs vs 7.4% with medically directed CRNAs, residents and/or fellows; relative risk, 1.02; 95% CI, 0.94-1.11). Thus, our effort to determine noninferiority (10% difference in relative risk) with other providers was inconclusive (P = .07). However, the medically directed SRNA group (0.8% [118]) was found to be noninferior (P < .001) to the matched group (1.0% [156]) on in-hospital mortality (relative risk, 0.75; 95% CI, 0.59-0.96).
Among 30,730 patients undergoing inpatient surgery at a single hospital, findings were inconclusive regarding whether exclusive medically directed SRNAs as in-room providers were noninferior to other providers. The use of medically directed SRNAs under this staffing model should be subject to further review. Clinical Trial and Registry URL: Not applicable.
2018年，美国麻醉医师协会指出，学生注册护士麻醉师（SRNA）“尚未完全具备合格的麻醉人员资质”。然而，与在麻醉医师医疗指导下的麻醉学进修医师或住院医师，或注册护士麻醉师（CRNA）相比，由SRNA在麻醉医师医疗指导下提供麻醉护理是否会影响术后结果仍不清楚。因此，我们旨在研究在医疗指导下担任室内麻醉提供者的SRNA是否会影响手术结果。
回顾性匹配队列分析。
2000年至2017年期间在一家三级学术医疗中心接受住院手术的成年患者（≥18岁）。
15365名仅由在医疗指导下的SRNA护理的患者与15365名由在医疗指导下的CRNA、麻醉学住院医师和/或进修医师护理的患者相匹配。
无。
主要综合结局是术后院内死亡和六类主要并发症（感染、出血、严重心脏、胃肠道、呼吸和泌尿系统并发症）。将院内死亡作为次要结局进行分析。
总共使用倾向得分匹配法匹配了30730例病例，以控制潜在的混杂因素。在2295例（7.5%）病例中确定了主要结局（由仅在医疗指导下的SRNA护理的患者为7.5%，由在医疗指导下的CRNA、住院医师和/或进修医师护理的患者为7.4%；相对风险，1.02；95%CI，0.94 - 1.11）。因此，我们确定与其他提供者相比是否非劣效（相对风险差异10%）的努力尚无定论（P = 0.07）。然而，发现在医疗指导下的SRNA组（0.8%[118例]）在院内死亡率方面不劣于匹配组（1.0%[156例]）（P < 0.001）（相对风险，0.75；95%CI，0.59 - 0.96）。
在一家医院接受住院手术的30730例患者中，关于仅由在医疗指导下的SRNA作为室内提供者是否不劣于其他提供者的研究结果尚无定论。在这种人员配备模式下使用在医疗指导下的SRNA应接受进一步审查。临床试验和注册网址：不适用。
