It Is Impossible To Measure The Impact Of This Decision By The Researchers On The Death, Complication

The data show that the death rate when nurse anesthetists were supervised by anesthesiologists was substantially lower than the death rate when nurse anesthetists were supervised by other physicians. However, the death rates cited in the abstract were more than 100 times the anesthesia-related death rates commonly reported in recent years, regardless of whether the nurse anesthetists were supervised by anesthesiologists or other physicians! This would lead one to conclude that the high death rates were almost certainly due to nonanesthesia factors, which would be more in keeping with the 30-day time frame of the study. Further, it has been noted by Dr. Michael Pine, a board-certified cardiologist widely recognized for his expertise in analyzing clinical data to evaluate healthcare outcomes, that after adjusting the death rates for case mix and severity, the patients whose nurse anesthetists were supervised by nonanesthesiologist physicians were about 15% more severely ill than the patients whose nurse anesthetists were supervised by anesthesiologists. The abstract provides no information to explain why the anesthesiologist-supervised cases involved less severely ill patients. Complication Rates: After adjusting for case mix and severity, the study found no statistically significant difference in complication rates when nurse anesthetists were supervised by anesthesiologists or other physicians. Dr. Pine noted that poor anesthesia care is far more likely to result in significant increases in complication rates than in significant increases in death rates. Therefore, Dr. Pine concluded that this finding strongly suggests that medical direction by anesthesiologists did not improve anesthesia outcomes. Failure to Rescue: For the most part, failure to rescue occurs when a physician is unable to save a patient who develops nonanesthesia complications following surgery. Therefore, it is not a relevant measure of the quality of anesthesia care provided by nurse anesthetists. Patients Involved in More than One Procedure: For reasons not explained in the abstract, patients involved in more than one procedure were assigned to the nonanesthesiologist physician group if for any of the procedures the nurse anesthetist was supervised by a physician other than an anesthesiologist. It is impossible to measure the impact of this decision by the researchers on the death, complication, and failure to rescue rates presented in the abstract.
To emphasize the importance of this, consider the following hypothetical scenario: A patient is admitted for hip replacement surgery. A nurse anesthetist, supervised by the surgeon, provides the anesthesia. The surgery is completed successfully. Three days later the patient suffers a heart attack while still in the hospital and is rushed into surgery. This time the nurse anesthetist is supervised by an anesthesiologist. An hour after surgery, and for reasons unrelated to the anesthesia care, the patient dies in recovery. According to the researchers, a case such as this would have been assigned to the nonanesthesiologist group!