Variation in anesthesiology provider-volume for complex gastrointestinal cancer surgery: a population-based study
Hallet J, Sutradhar R, Eskander A, Carrier FM, McIsaac D, Turgeon AF, d'Empaire PP, Idestrup C, Flexman A, Lorello G, Darling G, Kidane B, Kaliwal Y, Barabash V, Coburn N, Jerath A. Ann Surg. 2023; Jan 24 [Epub ahead of print]. DOI: https://doi.org/10.1097/sla.0000000000005811
Objective — Examine between-hospital and between-anesthesiologist variation in anesthesiology provider-volume (PV) and delivery of high-volume anesthesiology care.
Summary Background — Data Better outcomes for anesthesiologists with higher provider-volume (PV) of complex gastrointestinal cancer surgery have been reported. The factors linking anesthesiology practice and organization to volume are unknown.
Methods — We identified patients undergoing elective esophagectomy, hepatectomy, pancreatectomy using linked administrative health datasets (2007–2018). Anesthesiology PV was the annual number of procedures done by the primary anesthesiologist in the 2 years before the index surgery. High-volume anesthesiology was PV>6 procedures/year. Funnel plots to described variation in anesthesiology PV and delivery of high-volume care. Hierarchical regression models examined between-anesthesiologist and between-hospital variation in delivery of high-volume care use with variance partition coefficients (VPC) and median odds ratios (MOR).
Results — Among 7,893 patients cared for at 17 hospitals, funnel plots showed variation in anesthesiology PV (median ranging from 1.5, IQR 1-2 to 11.5, IQR 8–16) and delivery of HV care (ranging from 0 to 87%) across hospitals. After adjustment, 32% (VPC 0.32) and 16% (VPC 0.16) of the variation were attributable to between-anesthesiologist and between-hospital differences, respectively. This translated to an anesthesiologist MOR of 4.81 (95%CI 3.27–10.3) and hospital MOR of 3.04 (95%CI 2.14–7.77).
Conclusions — Substantial variation in anesthesiology PV and delivery of high-volume anesthesiology care existed across hospitals. The anesthesiologist and the hospital were key determinants of the variation in high-volume anesthesiology care delivery. This suggests that targeting anesthesiology structures of care could reduce variation and improve delivery of high-volume anesthesiology care.