Abstract
The present study evaluates the effect of anesthesiologist's experience in providing deep sedation for endoscopic retrograde cholangiopancreatography (ERCP) on cost and safety. Methodology. Perioperative records of 1167 patients who underwent ERCP were divided on the basis of anesthesiologist assisting these procedures either on regular basis (Group R) or on ad hoc basis (Group N). Comparisons were made for anesthesia times, complication rates, and airway interventions. Results. Across all American Society of Anesthesiologists (ASA) Classes, regular anesthesiologists were more efficient (overall mean anesthesia time in Group R was 24.82 ± 12.96 versus 48.63 ± 21.53 minutes in Group N). Within Group R, anesthesia times across all ASA classes were comparable. In Group N, anesthesia times for higher ASA status patients were significantly longer (ASA IV, 64.62 ± 35.78 versus ASA I, 45.88 ± 11.19 minutes). Intubation rates (0.76% versus 12.8%) and median minimal oxygen saturation (100% versus 97.01%) were significantly higher in Group R. Had Group R anesthesiologists performed all procedures, the hospital could have saved US $ 758536 (based upon operating room time costs). Conclusion. Experience in providing deep sedation improved patient safety and decreased the operating room turnaround time, thereby lowering operating room costs associated with these procedures.
Highlights
Achieving “efficiency without compromising safety” is the new mantra in medicine
The results highlight the time-based efficiency of the anesthesiologists providing deep sedation on a regular basis along with increased safety and a possible economic advantage
This is supported by significantly lower anesthesia times and higher values of minimal oxygen saturation noted during the procedures supervised by “regular anesthesiologists.”
Summary
Specialization and training in a chosen area have already been implemented successfully in many fields of anesthesiology. Obstetrics, pediatric, and neuroanaesthesia have already received recognition with dedicated fellowships programs. Anesthesia for many procedures that are done by anesthesiologists in remote diagnostic/therapeutic locations (out of operating room (OR)) is poorly studied. Most of these procedures are conducted under deep sedation (previously termed “Monitored Anesthesia Care (MAC)”). The risk of complications in out of OR is similar to OR anesthesia [1]. Formal specialization may not be necessary in this growing field, having a core group of interested anesthesiologists might help to drive efficiency without altering the safety
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