Variation in Frequency of Intraoperative Arterial, Central Venous and Pulmonary Artery Catheter Placement During Kidney Transplantation: An Analysis of Invasive Monitoring Trends

Nagrebetsky, Alexander; Dutton, Richard P.; Ehrenfeld, Jesse M.; Urman, Richard D.

doi:10.1007/s10916-018-0920-y

Cited by 3 publications

(4 citation statements)

References 19 publications

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“…NACOR has been used previously for other epidemiological studies of anesthesia utilization, complications, and quality. ( 15,16 )…”

Section: Methodsmentioning

confidence: 99%

“…NACOR has been aRtICle INFoRMatIoN: used previously for other epidemiological studies of anesthesia utilization, complications, and quality. (15,16) The population of interest included individuals with cirrhosis or portal hypertension complications as identified by ICD-9 or CPT codes. To identify patients with cirrhosis, validated ICD-9 codes for cirrhosis were utilized (ICD-9: 571.2, 571.5, and 571.6).…”

Section: Database and Populationmentioning

confidence: 99%

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Complications Associated With Anesthesia Services in Endoscopic Procedures Among Patients With Cirrhosis

et al. 2020

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BaCKgRoUND aND aIMS: Anesthesia services for endoscopic procedures have proliferated with the promise of increased comfort and safety. Cirrhosis patients are higher risk for sedation, yet limited data are available describing anesthesia complications in this population. appRoaCH aND ReSUltS: This cross-sectional study utilized the National Anesthesia Clinical Outcomes Registry, a multicenter quality-improvement database from 2010 to 2015. Patients with cirrhosis undergoing an endoscopy were identified by International Classification of Diseases, Ninth Revision (ICD-9)/Current Procedures Terminology (CPT) codes. The outcome of interest was serious anesthesia-related complication defined as cardiovascular, respiratory, neurological, drug related, patient injury, death, or unexpected admission. A mixed-effects multivariate logistic regression model determined odds ratios (ORs) between variables and serious complications, adjusting for potential confounders. In total, 9,007 endoscopic procedures were performed among patients with cirrhosis; 92% were esophagogastroduodenoscopies. The majority (81%) were American Society of Anesthesiologists (ASA) class ≥3, and 72% had a history of hepatic encephalopathy, ascites, varices, hepatorenal syndrome, or spontaneous bacterial peritonitis identified by ICD-9/CPT codes. In total, 87 complications were reported, 33 of which were serious. Frequency

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“…NACOR has been used previously for other epidemiological studies of anesthesia utilization, complications, and quality. ( 15,16 )…”

Section: Methodsmentioning

confidence: 99%

Section: Database and Populationmentioning

confidence: 99%

Complications Associated With Anesthesia Services in Endoscopic Procedures Among Patients With Cirrhosis

et al. 2020

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“…The authors included 10 580 kidney transplant anesthetics from 100 hospitals in the analysis. 22 An AC was utilized in 16% of transplants, CVC in 24% of transplants, and pulmonary artery catheter in 0.5% of transplants. Overall, significant variability in invasive monitoring was seen between institutions, with 50% of facilities who reported more than 50 kidney transplants placing no invasive lines.…”

Section: Kidney Transplantationmentioning

confidence: 99%

“…The NACOR study calls into question the use of invasive access, which exposes patients to the risks associated with invasive monitoring, particularly with central venous access, 23 when many centers perform the majority of cases without invasive lines. Nagrebetsky et al 22 call for standardization to improve the value of medical care across the nation. Others consider using multiple, complementary hemodynamic monitors to decrease CVC use, including arterial line systolic pressure variation, pulse pressure variation, stroke volume variation, noninvasive cardiac output monitors, and transesophageal echocardiography (TEE).…”

Section: Kidney Transplantationmentioning

confidence: 99%

Abdominal Organ Transplantation: Noteworthy Literature in 2018

Zerillo

Schlichting

Sakai

2019

Semin Cardiothorac Vasc Anesth

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A PubMed search revealed 1382 articles on pancreatic transplantation, 781 on intestinal transplantation, more than 7200 on kidney transplantation, and more than 5500 on liver transplantation published between January 1, 2018, and December 31, 2018. After narrowing the list down to human studies, 436 pancreatic, 302 intestinal, 1920 liver, and more than 2000 kidney transplantation studies were screened for inclusion in this review.

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Trends in Central Venous Catheter Insertions by Anesthesia Providers: An Analysis of the Medicare Physician Supplier Procedure Summary From 2007 to 2016

Rubin

Apfelbaum

Tung

2020

Anesthesia &Amp; Analgesia

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BACKGROUND: Central line insertion is a core skill for anesthesiologists. Although recent technical advances have increased the safety of central line insertion and reduced the risk of central line–associated infection, noninvasive hemodynamic monitoring and improved intravenous access techniques have also reduced the need for perioperative central venous access. We hypothesized that the number of central lines inserted by anesthesiologists has decreased over the past decade. To test our hypothesis, we reviewed the Medicare Physician Supplier Procedure Summary (PSPS) database from 2007 to 2016. METHODS: Claims for central venous catheter placement were identified in the Medicare PSPS database for nontunneled and tunneled central lines. Pulmonary artery catheter insertion was included as a nontunneled line claim. We stratified line insertion claims by specialty for Anesthesiology (including Certified Registered Nurse Anesthetists and Anesthesiology Assistants), Surgery, Radiology, Pulmonary/Critical Care, Emergency Physicians, Internal Medicine, and practitioners who were not anesthesia providers such as Advanced Practice Nurses (APNs) and Physician Assistants (PAs). Utilization rates per 10,000 Medicare beneficiaries were then calculated by specialty and year. Time-based trends were analyzed using Joinpoint linear regression, and the Average Annual Percent Change (AAPC) was calculated. RESULTS: Between 2007 and 2016, total claims for central venous catheter insertions of all types decreased from 440.9 to 325.3 claims/10,000 beneficiaries (AAPC = −3.4, 95% confidence interval [CI], −3.6 to −3.2: P < .001). When analyzed by provider specialty and year, the number of nontunneled line insertion claims fell from 43.1 to 15.9 claims/10,000 (AAPC = −7.1; −7.3 to −7.0: P < .001) for surgeons, from 21.3 to 18.5 claims/10,000 (AAPC = −2.5; −2.8 to −2.1: P < .001) for radiologists, and from 117.4 to 72.7 claims/10,000 (AAPC = −5.2; 95% CI, −6.3 to −4.0: P < .001) for anesthesia providers. In contrast, line insertions increased from 18.2 to 26.0 claims/10,000 (AAPC = 3.2; 2.3–4.2: P < .001) for Emergency Physicians and from 3.2 to 9.3 claims/10,000 (AAPC = 6.0; 5.1–6.9: P < .001) for PAs and APNs who were not anesthesia providers. Among anesthesia providers, the share of line claims made by nurse anesthetists increased by 14.5% over the time period. CONCLUSIONS: We observed a 38.3% decrease in claims for nontunneled central lines placed by anesthesiologists from 2007 to 2016. These findings have implications for anesthesiology resident training and maintenance of competence among practicing clinicians. Further research is needed to clarify the effect of decreasing line insertion numbers on line insertion competence among anesthesiologists.

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Variation in Frequency of Intraoperative Arterial, Central Venous and Pulmonary Artery Catheter Placement During Kidney Transplantation: An Analysis of Invasive Monitoring Trends

Cited by 3 publications

References 19 publications

Complications Associated With Anesthesia Services in Endoscopic Procedures Among Patients With Cirrhosis

Complications Associated With Anesthesia Services in Endoscopic Procedures Among Patients With Cirrhosis

Abdominal Organ Transplantation: Noteworthy Literature in 2018

Trends in Central Venous Catheter Insertions by Anesthesia Providers: An Analysis of the Medicare Physician Supplier Procedure Summary From 2007 to 2016

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