Wednesday, March 8, 2017

It's Anesthesia's Fault


It's a common refrain among surgeons that if something goes wrong, it's always anesthesia's fault. Whether there was excessive intraop bleeding or prolonged postop ileus, inevitably the surgeon will deflect responsibility and tell the patient it was the actions of the anesthesiologist that led to the complication.

Now there is a study to try to identify the extent to which the anesthesiologist is responsible for surgical morbidity and mortality. Presented at the ASA annual meeting last year, the authors evaluated one million cases culled from the Medicare database. They looked at three surgical procedures in particular: AAA repair, CABG, and colectomy. From these, they attempted to eliminate all possible other causes of surgical complications so that the focus was only on the anesthesiologist involved in the case.

What they found was that the anesthesiologist was responsible for 3.1%-4.5% of complications. As a matter of fact, the difference in complication rates between the lowest performing and highest performing anesthesiologists varied by a factor of three. For comparison, they found that surgeons were responsible for 4.2%-5.2%.

So maybe there is something to the myth that everything is anesthesia's fault. By everything I mean 3%-5% of cases. But if there is even one legitimate anesthesia complication, it will naturally balloon up to encompass all the ills of the operating suite. It's a good thing we have a great lifestyle to compensate for this insanity.

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