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Outcomes/Effectiveness Research

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Both hospital characteristics and board certification of anesthesiologists affect patient outcomes

Patients undergoing surgery aided by experienced anesthesiologists who are not board certified suffer more deaths or failure to rescue (rate of death after complications) than patients of midcareer board-certified anesthesiologists. However, the poor outcomes associated with noncertified anesthesiologists may be a result of the hospitals at which they practice and not necessarily their manner of practice, according to a recent study that was supported in part by the Agency for Healthcare Research and Quality (HS06560 and HS09469).

The researchers found that noncertified anesthesiologists were more likely than those with board certification to practice at hospitals with fewer characteristics associated with quality care. Such factors include hospital size, nurse-to-bed ratio, percentage of board-certified surgical staff, presence of a trauma center, and others. These hospital factors play an important role in determining patient outcomes, explains Jeffrey H. Silber, M.D., Ph.D., of the University of Pennsylvania School of Medicine.

Dr. Silber and his colleagues analyzed Medicare claims records for nearly 145,000 elderly Pennsylvania patients who underwent general surgical or orthopedic procedures between 1991 and 1994. They compared the outcomes of 8,894 patients who had midcareer anesthesiologists (11-25 years after medical school graduation) who lacked board certification with all other cases.

After adjusting for other factors affecting patient risk of death, the odds of death and failure to rescue were both 13 percent greater when care was delivered by noncertified midcareer anesthesiologists. This corresponded to 3.8 excess deaths and 9.2 excess deaths following complications (failure to rescue) per 1,000 patients. Adjusting for international medical school graduates did not change these results. In addition, hospital characteristics often associated with improved quality were consistently less evident in the noncertified group.

In summary, the researchers note that the current study provides strong evidence that anesthesiologist board certification status is an important factor associated with surgical outcomes, but it must not be used in isolation. They conclude that midcareer anesthesiologists who lack board certification and the hospitals in which they are employed appear to be associated with worse outcomes for surgical patients.

See "Anesthesiologist board certification and patient outcomes," by Dr. Silber, Sean K. Kennedy, M.D., Orit Even-Shoshan, M.S., and others, in the May 2002 Anesthesiology 96(5), pp. 1044-1052.

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