The Time is Now for Board Certification in Cardiac Anesthesia

Troianos, Christopher A.

doi:10.1053/j.jvca.2019.11.031

Cited by 8 publications

(7 citation statements)

References 3 publications

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“…However, care organization models that ensure increased predictability of surgeon-anesthesiology dyads, while balancing scheduling needs can exist. Indeed, this is currently possible in cardiac surgery . Because complex gastrointestinal cancer surgery is mostly performed on an elective basis, it appears well suited to adjusting care organization whereby human resources can be planned and organized around a specific schedule.…”

Section: Discussionmentioning

confidence: 99%

Association Between Familiarity of the Surgeon-Anesthesiologist Dyad and Postoperative Patient Outcomes for Complex Gastrointestinal Cancer Surgery

et al. 2023

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ImportanceThe surgeon-anesthesiologist teamwork and relationship is crucial to good patient outcomes. Familiarity among work team members is associated with enhanced success in multiple fields but rarely studied in the operating room.ObjectiveTo examine the association between surgeon-anesthesiologist dyad familiarity—as the number of times working together—with short-term postoperative outcomes for complex gastrointestinal cancer surgery.Design, Setting, and ParticipantsThis population-based retrospective cohort study based in Ontario, Canada, included adults undergoing esophagectomy, pancreatectomy, and hepatectomy for cancer from 2007 through 2018. The data were analyzed January 1, 2007, through December 21, 2018.ExposuresDyad familiarity captured as the annual volume of procedures of interest done by the surgeon-anesthesiologist dyad in the 4 years before the index surgery.Main Outcomes and MeasuresNinety-day major morbidity (any Clavien-Dindo grade 3 to 5). The association between exposure and outcome was examined using multivariable logistic regression.ResultsSeven thousand eight hundred ninety-three patients with a median age of 65 years (66.3% men) were included. They were cared for by 737 anesthesiologists and 163 surgeons who were also included. The median surgeon-anesthesiologist dyad volume was 1 (range, 0-12.2) procedures per year. Ninety-day major morbidity occurred in 43.0% of patients. There was a linear association between dyad volume and 90-day major morbidity. After adjustment, the annual dyad volume was independently associated with lower odds of 90-day major morbidity, with an odds ratio of 0.95 (95% CI, 0.92-0.98; P = .01) for each incremental procedure per year, per dyad. The results did not change when examining 30-day major morbidity.Conclusions and RelevanceAmong adults undergoing complex gastrointestinal cancer surgery, increasing familiarity of the surgeon-anesthesiologist dyad was associated with improved short-term patient outcomes. For each additional time that a unique surgeon-anesthesiologist dyad worked together, the odds of 90-day major morbidity decreased by 5%. These findings support organizing perioperative care to increase the familiarity of surgeon-anesthesiologist dyads.

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Section: Discussionmentioning

confidence: 99%

Association Between Familiarity of the Surgeon-Anesthesiologist Dyad and Postoperative Patient Outcomes for Complex Gastrointestinal Cancer Surgery

et al. 2023

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“…Such approaches have yielded better outcomes in cardiac surgery and led to the creation of subspecialty groups for cardiac anesthesiology. 51,52 It has also been shown as feasible in vascular surgery. 22 Because complex gastrointestinal cancer surgery is mostly performed on an elective basis, it seems well suited to a change in anesthesiology care organization whereby human resources can be planned and organized around a specific schedule.…”

Section: Discussionmentioning

confidence: 99%

“…For example, this can be achieved via dedicated or specialized anesthesiology teams, core specialty anesthesiology champions, or fellowship-level specialized training. Such approaches have yielded better outcomes in cardiac surgery and led to the creation of subspecialty groups for cardiac anesthesiology 51,52 . It has also been shown as feasible in vascular surgery 22 .…”

Section: Discussionmentioning

confidence: 99%

The Association Between Hospital High-volume Anesthesiology Care and Patient Outcomes for Complex Gastrointestinal Cancer Surgery

Hallet

Jerath

d’Empaire³

et al. 2022

Annals of Surgery

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Objective: To examine the association of between hospital rates of high-volume anesthesiology care and of postoperative major morbidity. Background: Individual anesthesiology volume has been associated with individual patient outcomes for complex gastrointestinal cancer surgery. However, whether hospital-level anesthesiology care, where changes can be made, influences the outcomes of patients cared at this hospital is unknown. Methods: We conducted a population-based retrospective cohort study of adults undergoing esophagectomy, pancreatectomy, or hepatectomy for cancer from 2007 to 2018. The exposure was hospital-level adjusted rate of high-volume anesthesiology care. The outcome was hospital-level adjusted rate of 90-day major morbidity (Clavien-Dindo grade 3–5). Scatterplots visualized the relationship between each hospital’s adjusted rates of high-volume anesthesiology and major morbidity. Analyses at the hospital-year level examined the association with multivariable Poisson regression. Results: For 7893 patients at 17 hospitals, the rates of high-volume anesthesiology varied from 0% to 87.6%, and of major morbidity from 38.2% to 45.4%. The scatter plot revealed a weak inverse relationship between hospital rates of high-volume anesthesiology and of major morbidity (Pearson: −0.23). The adjusted hospital rate of high-volume anesthesiology was independently associated with the adjusted hospital rate of major morbidity (rate ratio: 0.96; 95% CI, 0.95–0.98; P<0.001 for each 10% increase in the high-volume rate). Conclusions: Hospitals that provided high-volume anesthesiology care to a higher proportion of patients were associated with lower rates of 90-day major morbidity. For each additional 10% patients receiving care by a high-volume anesthesiologist at a given hospital, there was an associated reduction of 4% in that hospital’s rate of major morbidity.

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“…During 2020 health systems around the world were stretched to breaking point managing the coronavirus disease 2019 (covid- 19) pandemic. Nevertheless, we were told that the time is now to standardise sedation training, 1 differentiate service delivery, 2 certify cardiac anaesthetists, 3 address the mental health impact of climate change, 4 and end the HIV epidemic. 5 Two articles claimed that the time is now to consider universal mask wearing to protect against covid-19 which, to be fair, was timeous.…”

Section: Introductionmentioning

confidence: 99%

The time to act is now: pseudo-systematic review

Ford

Brigden²,

Ellman

et al. 2020

BMJ

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Objective To identify any medical or public health rationale for claims that the time to act is now. Design Pseudo-systematic review. Data sources PubMed. Study selection Studies that included the claim “time is now” in the title, with or without exclamation marks. No language or date restriction was applied. Results 512 articles were included for review. No relationship was identified between time to act and disease burden, severity, or specialty. Claims that the time to act was Christmas were almost entirely without basis. A clustering of claims that it is time to act in the first quarter of the year suggested a possible association with New Year’s resolutions. Conclusions Now is as good a time as any.

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The Time is Now for Board Certification in Cardiac Anesthesia

Cited by 8 publications

References 3 publications

Association Between Familiarity of the Surgeon-Anesthesiologist Dyad and Postoperative Patient Outcomes for Complex Gastrointestinal Cancer Surgery

Association Between Familiarity of the Surgeon-Anesthesiologist Dyad and Postoperative Patient Outcomes for Complex Gastrointestinal Cancer Surgery

The Association Between Hospital High-volume Anesthesiology Care and Patient Outcomes for Complex Gastrointestinal Cancer Surgery

The time to act is now: pseudo-systematic review

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