Physician anaesthetists versus non-physician providers of anaesthesia for surgical patients.

Abstract

Background There is an increasing demand for surgery, pressure on healthcare providers to reduce costs, and a predicted shortfall in the number of medically qualified anaesthetists. This review aimed to consider whether anaesthesia can be provided equally effectively and safely by nurse anaesthetists (without medical qualifications) as by medically qualified anaesthetists with specialist training. Study characteristics The evidence was current up to 13 February 2013. We found six relevant studies, five of which were large observational studies from the US with a comparison group and with study durations from two to 11 years, and one was a much smaller 12 week study from Haiti. There were over 1.5 million participants in the studies. Information for these studies was taken from American insurance databases (Medicare) and from hospital records. The small study was based on emergency medical care after the 2008 hurricanes in Haiti. Key results Most studies stated that there was no difference in the number of people who died when given anaesthetic by either a nurse anaesthetist or a medically qualified anaesthetist. One study stated that there was a lower rate of death for nurse anaesthetists compared to medically qualified anaesthetists. One study stated that the risk of death was lower for nurse anaesthetists compared to those being supervised by an anaesthetist or working within an anaesthetic team, whilst another stated the risk of death was higher compared to a supervised or team approach. Other studies gave varied results. Similarly, there were variations between studies for the rates of complications for patients depending on their anaesthetic provider. Quality of the evidence Much of the data came from large databases, which may have contained inaccuracies in reporting. There may also be important differences between patients that might account for variation in study results, for example, whether patients who were more ill were treated by a medically qualified anaesthetist, or whether nurse anaesthetists worked in hospitals that had fewer resources. Several of the studies had allowed for these potential differences in their analysis, however it was unclear to us whether this had been done sufficiently well to allow us to be confident about the results. There was also potential confounding from the funding sources for some of these studies. Conclusion As none of the data were of sufficiently high quality and the studies presented inconsistent findings, we concluded that it was not possible to say whether there were any differences in care between medically qualified anaesthetists and nurse anaesthetists from the available evidence.