Journal article
Hypotension during induction of anaesthesia is neither a reliable nor a useful quality measure for comparison of anaesthetists’ performance
British Journal of Anaesthesia, Vol.119(1), pp.106-114
07/2017
DOI: 10.1093/bja/aex153
PMID: 28974070
Abstract
Identification of statistically reliable outcomes for comparison among anaesthetists is challenging. Time-weighted intraoperative mean arterial pressure <65 mm Hg (AUC65) is associated with increased odds for myocardial damage. We explored retrospectively whether such hypotension before incision was statistically reliable for peer comparison. We retrieved electronic data between 2006 and 2015 at a tertiary care, academic hospital in the USA for patients at risk for myocardial damage (inpatient after surgery, ASA physical status ≥III, ≥50 yr of age, and case duration ≥60 min). We determined the percentage of anaesthetists comparable based on caseload and case-mix. The AUC65 was compared amongst anaesthetists supervising ≥100 cases involving at-risk patients during the last 12 months. Only 14.1% [95% confidence interval (CI) 13.6–14.5%] of cases involved patients who were ‘at risk’ during the 10 yr study period. A yearly average of 49 (sd 6) anaesthetists supervised ≥100 cases of any type, of whom only 52% (95% CI 47.1–56.0%) supervised ≥100 cases involving at-risk patients. Thus, nearly half the anaesthetists would have been excluded from peer comparison. During the last 12 months, there were two outliers among 34 evaluable anaesthetists (P<0.05, controlling for false discovery). However, their contribution to total hypotension amongst cases for all patients was small, because hypotension was widely distributed (e.g. 80% of hypotension attributable to 61.8% of anaesthetists, 95% CI 59.8–63.7%). There was no relationship between the AUC65 and propofol induction dose. The AUC65 of time-weighted pre-incision hypotension is not a suitable metric for comparing anaesthetists. There were few at-risk patients, half the anaesthetists were not evaluable because of their case-mix and caseload, and hypotension was widely distributed.
Details
- Title: Subtitle
- Hypotension during induction of anaesthesia is neither a reliable nor a useful quality measure for comparison of anaesthetists’ performance
- Creators
- R.H Epstein - Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, FL 33136, USAF Dexter - Department of Anesthesia, University of Iowa, Iowa City, IA 52242, USAE.S Schwenk - Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA 19107, USA
- Resource Type
- Journal article
- Publication Details
- British Journal of Anaesthesia, Vol.119(1), pp.106-114
- Publisher
- Elsevier Ltd
- DOI
- 10.1093/bja/aex153
- PMID
- 28974070
- ISSN
- 0007-0912
- eISSN
- 1471-6771
- Language
- English
- Date published
- 07/2017
- Academic Unit
- Health Management and Policy; Anesthesia
- Record Identifier
- 9983806250102771
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