The contribution of the anaesthetist to risk‐adjusted mortality after cardiac surgery
| Autor: | Papachristofi, O., Sharples, L. D., Mackay, J. H., Nashef, S. A. M., Fletcher, S. N., Klein, A. A., Lau, G, Woodward, D, Hillier, J, Ware, M, Agarwal, S, Bill, M, Gill, R, Duthie, D, Skinner, H |
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| Rok vydání: | 2015 |
| Předmět: |
Male
Risk Surgical results medicine.medical_specialty Patient risk 03 medical and health sciences Postoperative Complications 0302 clinical medicine Primary outcome Anesthesiology 030202 anesthesiology Physicians health services administration medicine Humans Hospital Mortality Prospective Studies 030212 general & internal medicine Cardiac Surgical Procedures Intensive care medicine Prospective cohort study Aged Risk adjusted business.industry General surgery EuroSCORE Original Articles United Kingdom Cardiac surgery surgical procedures operative Anesthesiology and Pain Medicine Original Article Female Clinical Competence business |
| Zdroj: | Anaesthesia |
| ISSN: | 1365-2044 0003-2409 |
| Popis: | Summary It is widely accepted that the performance of the operating surgeon affects outcomes, and this has led to the publication of surgical results in the public domain. However, the effect of other members of the multidisciplinary team is unknown. We studied the effect of the anaesthetist on mortality after cardiac surgery by analysing data collected prospectively over ten years of consecutive cardiac surgical cases from ten UK centres. Casemix‐adjusted outcomes were analysed in models that included random‐effects for centre, surgeon and anaesthetist. All cardiac surgical operations for which the EuroSCORE model is appropriate were included, and the primary outcome was in‐hospital death up to three months postoperatively. A total of 110 769 cardiac surgical procedures conducted between April 2002 and March 2012 were studied, which included 127 consultant surgeons and 190 consultant anaesthetists. The overwhelming factor associated with outcome was patient risk, accounting for 95.75% of the variation for in‐hospital mortality. The impact of the surgeon was moderate (intra‐class correlation coefficient 4.00% for mortality), and the impact of the anaesthetist was negligible (0.25%). There was no significant effect of anaesthetist volume above ten cases per year. We conclude that mortality after cardiac surgery is primarily determined by the patient, with small but significant differences between surgeons. Anaesthetists did not appear to affect mortality. These findings do not support public disclosure of cardiac anaesthetists' results, but substantially validate current UK cardiac anaesthetic training and practice. Further research is required to establish the potential effects of very low anaesthetic caseloads and the effect of cardiac anaesthetists on patient morbidity. |
| Databáze: | OpenAIRE |
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