Surgical Complications More Likely When Anesthesiologist Manage Overlapping Procedures

Anesthesiologists who handle overlapping procedures may be putting patients at an increased risk of experiencing surgical complications or death, according to the findings of a new study.

Every surgical treatment requires an anesthesiologist, and the same anesthesia care team often treats or oversees multiple patients at the same time, resulting in overlapping clinical responsibilities.

In a study published last week in the medical journal JAMA Surgery, researchers from the University of Michigan warned that patients treated by anesthesiologists who supervised three to four overlapping operations faced a 14% increased risk of death, when compared to patients involved in operations with an anesthesiologist covering only one or two overlapping surgeries.

Researchers evaluated data on nearly 579,000 major non-cardiac inpatient surgical procedures from 2010 to 2017, at 23 US academic and private hospitals. They used electronic health record registry data to group patients by how many were being treated by one anesthesiologist, including those covering one surgery, one to two surgeries, two to three, and three to four surgeries.

Patients underwent any number of different surgeries including orthopedic, gynecologic, neurologic, otolaryngologic, urologic, vascular and general surgeries. Patients were also identified by similar demographics and health status.

Overlapping Surgical Cases with One Anesthesiologist

Anesthesia is necessary to keep a patient unconscious and pain free during surgery. During that time the anesthesiologist monitors the patient’s vitals, including their breathing, blood pressure, heart rate, and heart rhythm, to ensure the patient is stable during the surgical procedure.

Patients are usually cared for by an anesthesiologist, but there are times when an anesthesiologist cares for multiple patients in overlapping surgeries while directing a registered nurse anesthetist or a certified anesthesia assistant who remains in the operating room. This is the most common care model used to deliver anesthesia to patients in the U.S.

Patients cared for by teams where the anesthesiologist cared for three to four overlapping patients had a 14% increased risk of death and suffering complications. Patients of care teams who oversaw two to three patients in overlapping surgeries had a 4% increased risk of death and complications.

Overall, 5% of all overlapping surgical cases resulted in some type of post-surgical complication including death within 30 days of surgery, or complications involving cardiac, respiratory, gastrointestinal, urinary, bleeding, and infections.

Anesthesiologists often say they can handle three or four patients at a time, but the new research indicates that model leads to more complications and may even increase the risk of death. This type of multiple patient overlapping model should be used in a limited capacity, perhaps only for some of the simplest surgeries that carry the lowest risks, the researchers concluded.

Patients undergoing high risk surgery or have complex medical histories should talk to their anesthesiologist before undergoing surgery about how many patients may be cared for at once.

“This study’s findings suggest that increasing overlapping coverage by anesthesiologists is associated with increased surgical patient morbidity and mortality,” the researchers wrote. “Therefore, the potential effects of staffing ratios in perioperative team models should be considered in clinical coverage efforts.”