Anaesthesia management by residents does not alter the incidence of self-reported anaesthesia awareness: A teaching hospital-based propensity score analysis

Abstract

BackgroundIntraoperative awareness during general anaesthesia is rare but represents one of the major anaesthesia-related complications. Intraoperative awareness may be a result of inadequate anaesthesia management. Therefore, the incidence can be related with the experience of anaesthetists. To assess whether the incidence of intraoperative awareness is related to anaesthetists’ experience, we compared the incidence of self-reported intraoperative awareness between patients managed by anaesthesia residents or by experienced anaesthetists. MethodsThis is a retrospective review of an institutional registry containing 21,606 general anaesthesia cases. It was conducted with the ethics board approval. Propensity score analysis was used to generate a set of matched cases (resident managements) and controls (anaesthetist managements), yielding 4940 matched patient pairs. The incidence of self-reported intraoperative awareness compared as primary outcomes. Additionally, a multivariate logistic analysis in the entire cohort, using the incidence of self-reported intraoperative awareness as dependent variable, was conducted to confirm the result of the primary outcome. ResultsIn the unmatched population, contrary to our hypothesis, the incidence of self-reported intraoperative awareness was lower in resident management compared with anaesthetist management (1.1% vs. 1.5%, P=0.028). However, after propensity score matching, there was no difference in incidences of self-reported intraoperative awareness (1.5% vs. 1.3%, 0.38). The multivariate analysis confirmed the result of the primary outcome from the matched pair analysis and showed that ASA physical status (OR=1.40, 95% CI=1.08 to 1.81), emergency case (CI=2.05, 95% CI=1.40 to 3.00), and application of postoperative analgesia (OR=0.70, 95% CI=0.50 to 0.97) were independently associated with incidence of self-reported intraoperative awareness. ConclusionIn conclusion, when supervised by an anaesthetist, resident anaesthesia management is not more likely to result in complaints about intraoperative recall than anaesthetist management.