The anaesthetist makes a difference: the bottom line matters!

Abstract

Editor, The editorial by Clergue1 critically discusses the heterogeneity of the composition of the anaesthesia team in different European countries. On the basis of the survey by Meeusen et al.,2 the author recommends standardisation of the training, responsibilities and limitations of non-physician anaesthesia providers. The editorial further raises a question that is of utmost importance to our specialty: what is the role of non-physician anaesthesia providers in Europe, given the increasing workload combined with an expected shortage of anaesthesiologists and considerable financial restraints? Clergue states that anaesthesia-related mortality rates are similar when comparing countries that allow nurses to maintain (and possibly deliver) anaesthesia without direct supervision of an anaesthesiologist and countries that do not. The author cites these rates to be 0.7, 0.8 and 0.55 deaths per 100 000 for France, the Netherlands and Australia, respectively.1 This information deserves comment, as it is misleading at best and probably incorrect. The two publications cited by Clergue indicate one death per 15 385 anaesthetics in France3 and one death per 7307 anaesthetics in the Netherlands4 that are completely or partially related to anaesthesia. Both of these countries have nurse anaesthetists. In Australia, the incidence of anaesthesia-related deaths is 1: 53 462 as reported by the Australian and New Zealand College of Anaesthetists. Thus, in Australia where only physicians are allowed to deliver and maintain anaesthesia, the reported mortality rate is 3.5 times less than in France and 7.3 times less than in the Netherlands.5 Taking into account the numerous methodological limitations acknowledged by the authors of these reports,3–5 it may be concluded that a direct comparison between different countries is not valid and future studies are warranted to help decide if a nurse anaesthetist or a ‘physician only’ anaesthetist model provides better safety for our patients. It is not reasonable, however, to conclude that the mortality rates are similar! The answer to a shortage of anaesthesiologists should not be a reduction in quality, but instead an increase in training places, training settings and other strategies to increase the supply of anaesthetists. The colleges and societies have a duty to raise our image, the image of the physician anaesthetists. Indeed, we should ask ourselves whether the public would consider having their operation performed by a ‘surgeon’ who is not a physician.