PATIENT SAFETY STUDY HIGHLIGHTS COST-EFFECTIVE ADVANTAGES
OF ANESTHESIOLOGIST-DIRECTED CARE
John P. Abenstein, M.D. ASA ANNUAL MEETING
CONTACT:
Denise M. Jones
Philip S. Weintraub
(847) 825-5586
Oct. 9-13 (214) 853-8010
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DALLAS -- An anesthesiologist's involvement in the care of surgical patients improves quality, reduces complications, saves lives and achieves these benefits cost-effectively compared to many other medical services, according to the results of a study reported at the American Society of Anesthesiologists annual meeting.
The study suggests that the availability of anesthesiologists should be considered a benchmark indicator of quality at hospitals, clinics and managed care companies, researchers from the Mayo Clinic said.
Based on data from a recent government-sponsored study, for every 1,000 anesthetics delivered, eight more patients will be alive if the anesthetic is administered with involvement of an anesthesiologist rather than by other methods of anesthesia administration that do not involve an anesthesiologist.
The cost-effectiveness of medical treatment is determined by comparing the cost of the treatment and its impact on the patient's life expectancy rate. When cost is divided by the expected longevity of the average patient, this is referred to as "cost-per-life-year-saved."
Using the services of an anesthesiologist has been found to be just a fraction of the cost of routine medical care, Dr. Abenstein said.
The cost-per-life-year-saved due to the medical care of an anesthesiologist is $1,788. This compares favorably to the cost-per-life-year-saved for other key medical services, including cardiac bypass surgery ($6,000 per life-year saved), PAP smears ($11,000), kidney dialysis ($40,000) and mammograms ($105,000).
"In short, having an anesthesiologist on board offers good value for the money," John P. Abenstein, M.D., a consultant in anesthesiology at the Mayo Clinic, said.
The researchers analyzed data from a 1998 University of Pennsylvania study of 65,000 Medicare patients. The data revealed a 28-percent decrease in the death rate within 30 days of surgery among patients treated in facilities that included board-certified anesthesiologists.
The death rate was 3.7 percent in facilities where nurse anesthetists were supervised by just surgeons, compared to only 2.9 percent for practices in which nurse anesthetists were supervised by anesthesiologists.
The difference between the two types of practices translates into eight more patients living for every 1,000 anesthetics delivered when an anesthesiologist is involved.
The benefits of that involvement actually may be even greater than these numbers suggest, Dr. Abenstein said. "Anesthesia practices that do not include anesthesiologists generally provide care for healthier patients who have less complex procedures," he said. "In other words, the type of practice one would expect to result in fewer deaths actually results in more."
Using data from the 1998 study, along with published salary data for nurse anesthetists and anesthesiologists, the researchers determined the costs associated with the improved outcomes. "Anesthesiologists have higher incomes than nurse anesthetists. We wanted to know how those extra costs would compare to the cost-benefits of other key medical services," Dr. Abenstein said.
The analysis revealed that an anesthetic with an anesthesiologist costs $143 more than an anesthetic with a nurse anesthetist who is not supervised by an anesthesiologist. When combined with the findings of the University of Pennsylvania study, this translates into $1,788 per life-year saved.
The true cost actually may be even less than $1,788, Dr. Abenstein noted. In analyzing the data, the researchers compared anesthesiologists' total income, which can include earnings from pain management and other services, against nurse anesthetists' total income, which comes from surgical anesthesia alone. "If we had looked at anesthesiologists' income from surgical anesthesia alone, the cost of having an anesthesiologist involved in surgical care would be even lower," he said.
"The best patient outcomes are found in practices that include anesthesiologists," Dr. Abenstein said. "Is having an anesthesiologist involved worth the extra cost? We believe so, considering the cost of other medical procedures."
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