bad research…or bad reporting?

This is an example of the perils (morbidity, mortality, and financial) of mathematical manipulation of data by researchers in basing broad conclusions without more fully understanding the processes and externalities involved:

Unnecessary anesthesia adds $1B to health spending – FierceHealthcare

Very misleading…

Trained anesthesia is called for in healthy patients because untrained surgeons and nurses were harming or killing ‘healthy’ people by over sedating them. I personally saw this on a couple of occasions, and also know that close calls are often not reported.

A similar problem occurred with liposuction in physicians offices in Florida…untrained people in charge of sedating, or CRNAs being coerced by surgeons to take bad risks in the interest of decreasing cost.

In both situations, facilities were later required (or by their own volition chose) to have adequate anesthesia supervision.

Ask any anesthesiologist about the mishaps at their facilities that have occurred during colonoscopies when left to the GI docs and nurses.  This isn’t a one-in-a-million possibility of a mishap, it’s common.

To clarify:

The procedure is not dangerous if someone is there who has had years of experience evaluating and handling sedation and airways. That means a CRNA, AA, or Anesthesiologist.


To attack the conclusion of this article from another viewpoint…

The throughput of scope procedures when anesthesia personnel are present can be double or triple that without anesthetists present. This needs to be taken into account when calculating costs.

The researcher should have focused on the cost due to incidence of bowel perforation under deeper anesthesia when the anesthetist is present vs the cost of prolonged hospital stay due to poor sedation technique without anesthetist plus the expense of awards and defending against lawsuits.

Also, opportunity costs saved to all participants from the additional time would be similar (though less) to those accrued in a study where anesthetist were involved in pediatric radiation (higher ratio of 6 to 1 return in time saved, multiplied by the number of people involved).  The value of these costs are often dispersed among different agents (patient, surgeon, radiologists, anesthetists, nurses, patient guardian or helper).

Externalities that are harder to quantify financially relate to the fact that anesthetists can sedate/sleep patients much faster, deeper, safer, and bring them back much quicker. The surgeon/GI, nurses, and patient can have an order of magnitude better experience.

Playing with numbers can be dangerous!…

About Brian D Gregory MD, MBA

Board Certified Anesthesiologist for 30 years. TOC design and implement for 30 years. MBA from U of Georgia '90: Finance, Data Management, Risk Management. Practiced in multiple US states and Saudi Arabia at KFSH&RC and KFMC Taught residents in two locations. Worked with CRNAs for 20 years.
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