Anesthesia OR efficiency: Does pediatric anesthesia fellowship training make a difference?
Stephen J. Gleich MD, Michael E. Nemergut MD PhD, and Myron Yaster MD
Does pediatric anesthesia subspecialty training make a difference in OR efficiency when compared to general anesthesiologists? Today’s PAAD by Carlson et al.1 investigated this question and the results of their study were published in the Journal of Pediatric Gastroenterology and Nutrition, a journal that I must admit is not on my radar of journals to review for the PAAD. So, thanks to Drs. Steve Gleich and Mike Nemergut of the Mayo Clinic for today’s PAAD. Steve and Mike are Board certified in pediatrics, anesthesiology, pediatric anesthesiology and pediatric critical care medicine. I, and hopefully you, can look forward for more of their reviews in the future. Myron Yaster MD
Original article
Carlson A, McElrath A, Herrera G, Patzkowski M. Pediatric Fellowship-Trained Anesthesiologists Improve Anesthesia-Controlled Time in a Pediatric Endoscopy Suite. J Pediatr Gastroenterol Nutr. 2023 Jun 1;76(6):813-816. PMID: 36917845
“Operating room (OR) costs can be grossly simplified to resource use and time. The attributed anesthesia time outside of the allotted procedure time variable is known as anesthesia-controlled time (ACT). ACT is the addition of 2 phases: the time from when a patient arrives in the OR and is under anesthesia ready for the procedure to begin, in addition to the time from when a procedure ends, and the patient is taken out of the OR. Optimizing ACT is a critical component to improving health care efficiency outside of procedure time variables. Silber et al. demonstrated that anesthesia providers with more experience optimize ACT, and ergo minimize OR delays.”1 Carlson et al.1 wondered “if fellowship trained pediatric anesthesiologists would be more efficient during esophagogastroduodenoscopy (EGD) and colonoscopy because of greater familiarity with both the procedure and complications unique to pediatric patients.”1, 2
This single center study was performed at the Brooke Army Medical Center on scheduled, non-emergent patients. The authors found that “fellowship-trained pediatric anesthesiologists were associated with a 3.7-minute reduction per case in ACT (95% CI: 2.005–5.478; P < 0.001) when compared to general practice anesthesiologists. Patient age was associated with a 0.4-minute (95% CI: –0.558 to –0.243; P < 0.001) decrease in ACT for each advancing year in age.”1
Even though OR costs are huge drivers of health care costs, and, as we discussed in a previous PAAD, multidisciplinary teams to optimize OR time for complex care patients improve efficiency3, does a 3.7 minute difference, as found in this study, really matter? We think the short answer is “maybe.” (Myron is a bit more dubious) (In the the famous words of Lloyd from the movie, Dumb & Dumber, "So you're telling me there is a chance? YEAH!") For example, 3.7 minutes makes little difference in longer cases (where there may only be a few cases scheduled in an OR for the day). However, 3.7 minutes per case adds up rather quickly for multiple short procedures. In a busy GI endoscopy room, with 15-20 cases per day, this would equate to a reduction in OR time of 55.5 minutes per day. More time to add on more cases!
We acknowledge that other targets causing far longer OR delays like the timely arrival and availability of surgeons, proceduralists, anesthesiologists, OR equipment, and personnel to rapidly turnover ORs also need to be considered in evaluating OR efficiency – and likely have a far greater impact.
Obviously, we think and have a vested interest in pediatric anesthesiology subspecialization and training. However, we don’t think the 4 minute difference in ACT found in this study is a major one of them. What do you think? Send your responses to Myron who will post in a Friday Reader Response.
References
1. Carlson A, McElrath A, Herrera G, Patzkowski M. Pediatric Fellowship-Trained Anesthesiologists Improve Anesthesia-Controlled Time in a Pediatric Endoscopy Suite. Journal of pediatric gastroenterology and nutrition. Jun 1 2023;76(6):813-816. doi:10.1097/mpg.0000000000003770
2. Talaat HS, Metwaly MA, Khafagy AH, Abdelraouf HR. Corrigendum to "Does passive smoking induce sensorineural hearing loss in children?" [Int. J. Pediatr. Otorhinolaryngol. 78 (1) (2014) 46-49]. International journal of pediatric otorhinolaryngology. Jul 2016;86:97. doi:10.1016/j.ijporl.2016.04.019
3. Ruiz AG, Bhatt JM, DeBoer EM, et al. Demonstrating the benefits of a multidisciplinary aerodigestive program. Laryngoscope. Feb 2020;130(2):521-525. doi:10.1002/lary.27939