The Association Between Anesthesia Resident Training Level and The Incidence of Intraoperative Adverse Events: A Retrospective Cohort Study

Document Type

Conference Proceeding

Publication Date

11-1-2024

Publication Title

Anesth Analg

Abstract

Introduction: In the emergency department, endotracheal intubations performed by less experienced physicians are associated with higher rates of adverse events such as hypotension and hypoxemia [1]. In the perioperative setting, anesthesia resident training level has been linked to differential risks of post-extubation desaturation [2]. However, it is unclear whether the training level of the anesthesia resident is associated with differential risks of intraoperative adverse events such as hypoxemia and hypotension in patients undergoing surgery. In this study, we hypothesized that anesthesia resident training level is associated with differential risks in the occurrence of intraoperative adverse events. Methods: This retrospective cohort study included 62,807 adult patients who underwent non-ambulatory, non-cardiac, non-transplant surgery with anesthesia care provided by an anesthesia resident as the primary provider under attending supervision at an academic healthcare center in the United States of America between 2009 and 2020 (Figure 1). The primary exposure was the training level of the anesthesiologist (CA-1 versus CA-2 versus CA-3). The primary outcome was a composite of intraoperative adverse events, defined as the occurrence of either arterial hypotension (mean arterial pressure <55 mmHg for ≥5 cumulative minutes) [3] or hypoxemia (peripheral oxygen saturation of <90% for an episode of >2 cohering minutes) [4]. We assessed the association between anesthesia resident training level and intraoperative adverse events using multivariable logistic regression adjusted for several patient- and procedural characteristics. Results: 22,078 (35.2%) patients received anesthesia care from CA-1 residents, while 19,961 (31.8%) and 20,768 (33.0%) patients received care from CA-2 and CA-3 anesthesia residents, respectively. Patients who received anesthesia care from CA-3 compared to CA-1 residents were on average older, had a higher comorbidity burden, and underwent more complex procedures (Table 1). Intraoperative adverse events occurred in 20.5% (n=12,887) of patients, while 18.0% (n=11,304) of patients experienced hypotension, and 3.3% (n=2,055) of patients experienced intraoperative hypoxemia. Compared to CA-1 residents, the risk of intraoperative adverse events was decreased if CA-2 residents provided anesthesia care (ORadj 0.92; 95%CI 0.88-0.97; P=0.003; Figure 2) and lowest if CA-3 residents provided anesthesia care (ORadj 0.84; 95%CI 0.80-0.89; P<0.001; Figure 2). This association was driven by lower rates of intraoperative hypotension among CA-2 (ORadj 0.91; 95%CI 0.87-0.97; P=0.001; Figure 2) and CA-3 residents (ORadj 0.83; 95%CI 0.79-0.88; P<0.001; Figure 2), respectively, while no differences were observed in the risk of hypoxemia across different training levels (CA-2 versus CA-1: ORadj 1.02; 95%CI 0.90-1.16; P=0.72 and CA-3 versus CA-1: ORadj 0.97; 95%CI 0.85-1.10; P=0.61; Figure 2). Conclusions: We observed a lower risk of intraoperative hypotension in anesthesia residents at higher training levels compared to early-career anesthesia residents. Based on our data, future studies are warranted to investigate underlying mechanisms and the potential relevance for patient outcomes after surgery as well as for anesthesia residency training and supervision. (Table Presented).

Volume

139

Issue

5

First Page

748

Last Page

750

Find It @ Sladen

Share

COinS