from a survey of anesthesia or medical staff at the two types of hospitals.
In the study sample there were 965 anesthetic complications and 17 deaths: 76 percent of the complications were classified as less serious according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), and only one of the deaths had an ICD-9-CM code associated with an anesthetic complication. The CRNA-only hospitals had a complication rate of 0.58 percent, while the anesthesiologist-only hospitals had a rate of 0.76 percent.
Regression analysis was used to adjust for independent variables such as hospital characteristics (geographic location, size, and teaching status), patient demographics (ages, primary payer, and type of admission), and patient commorbidities.
Several interesting patterns emerged from the data. The CRNA-staffed hospitals treated the greatest percentage of Medicaid, rural, teaching, urgent admission, and very young (under 17 years old) patients, while anesthesiologist-staffed hospitals had the greatest percentage of emergency admissions and older mothers (over 35 years old). Additionally, a substantially higher percentage of sicker patients were transferred to CRNA-only hospitals, a factor which could, potentially, affect the number of anesthetic complications at a facility. However, this did not prove to be the case.
"Hospitals and anesthesiology groups, particularly those in rural areas and those in medically underserved urban areas with large Medicaid populations, now have a possible long-term solution to their OB anesthesia staffing needs: greater use of CRNAs working without anesthesiologist supervision," Simonson said. He added that further studies are needed to validate the observations made from this study.
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