High-Volume Anesthesiologists Associated With Better GI Cancer Surgery Outcomes

By Lisa Rapaport

March 30, 2021

(Reuters Health) - Patients who undergo complex gastrointestinal cancer surgery have a lower risk of adverse events when they receive care from an anesthesiologist who's involved in a high volume of these procedures, a recent study suggests.

Researchers examined data on 8,096 patients (median age 65 years) who underwent esophagectomy, pancreatectomy, or hepatectomy performed by one of 186 surgeons supported by one of 842 anesthesiologists. The composite primary endpoint was 90-day major morbidity and readmission with high-volume anesthesiologists (at least 6 procedures a year or 75th percentile for volume) versus low-volume anesthesiologists.

The median anesthesiologist volume was 3 complex gastrointestinal cancer surgeries per year in the two years prior to the index surgery in the study, and a total of 2,166 patients (26.7%) received care from high-volume anesthesiologists.

Fewer patients experienced 90-day major morbidity or readmissions with high-volume anesthesiologists (36.3%) than with low-volume anesthesiologists (45.7%), researchers report in JAMA Surgery.

"With the increasing complexity of surgical procedures for esophageal, pancreatic, and hepatic resection, the perioperative anesthesiology management has become more complex as well, and the anesthesiology management needs to be tailored to the patient and the type of procedure being performed," said lead study author Dr. Julie Hallet, an assistant professor of surgery at the University of Toronto and a surgical oncologist at the Odette Cancer Centre-Sunnybrook Health Sciences Centre.

"Anesthesiologists who do more of those complex cases are more familiar with these practices and more comfortable with the specificities of complex GI surgery, such that they can deliver more procedure-appropriate care that can improve patient outcomes," Dr. Hallet said by email.

The adjusted analysis accounted for age, sex, comorbidities, rural residency, income, surgical procedure and approach, year of surgery, neoadjuvant therapy, anesthesiologist handover, surgeon volume, and institutional volume.

Compared with patients who had low-volume anesthesiologists, those with high-volume anesthesiologists had significantly lower chance of experiencing the primary endpoint (adjusted odds ratio 0.85). High-volume anesthesiologists were also associated with a significantly lower chance of 90-day morbidity (aOR 0.83), unplanned intensive care admissions (aOR 0.84), and readmissions (aOR 0.87), but not with readmission (aOR, 0.87) or mortality (aOR, 1.05).

Limitations of the study include the use of administrative claims data, which lack certain medical information, as well as the lack of consistent data on staging information, the study team notes.

Even so, the results add to evidence that there is a relationship between volume and surgical outcomes, said Dr. Ryan Merkow, of the Surgical Outcomes and Quality Improvement Center at the Feinberg School of Medicine at Northwestern University in Chicago.

"High quality care requires more than just an experienced surgeon. It requires an experienced anesthesiologist, operating room team, nurses and other specialists as well as thoughtful structural and process of care," Dr. Merkow, who wasn't involved in the study, said by email.

"It is important to elucidate these factors in order to apply them widely such that all patients can benefit from these best practices," Dr. Merkow added. "In anesthesia care, these practices may be particularly amenable to wide dissemination since it is less of a technical activity than surgery."

SOURCE: https://bit.ly/3ryDHCm and https://bit.ly/3dfizMq JAMA Surgery, online March 17, 2021.

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