Does Experience Matter

Myron Yaster

Leif Saager, Kurt Ruetzler, Alparslan Turan, Kamal Maheshwari, Barak Cohen, Jing Yo, Edward J Mascha, Yuwei Qiu, Ilker Ince, Daniel I Sessler.  Do It Often, Do It Better: Association Between Pairs of Experienced Subspecialty Anesthesia Caregivers and Postoperative Outcomes. A Retrospective Observational Study Anesth Analg 2021 Mar 1;132(3):866-877. PMID: 33433116

My good friend Chuck Berde once told me that if you see the name Henrik Kehlet on a paper read it!  I think the same can be said for Daniel Sessler. He is a giant in our profession and when one of his manuscripts is published I go out of my way to read it even if at first glance it’s not about our subspecialty, pediatric anesthesia.

What is the role of the anesthesiologist’s, or really the anesthesia care team’s, experience in postoperative outcomes?  It’s been known for a long time that it takes many hours of deliberate practice to become expert in most anything.   How long is long? In many studies, the magic number appears to be 50 or 10,000 hours (10 years). The role of experience in surgery is clear.  “Surgery subspecialization is common nowadays and is mostly driven by recognition of the relationship between volume, specialization, and surgical outcome. Yeo et al. evaluated 14,833 patients who had major rectal cancer resections and reported fewer complications when procedures were performed by surgeons with the highest annual and cumulative case volumes.” (Ann Surg. 2016;265:151–157).  

There has been little study of this issue in anesthesiology (and pediatric anesthesia practice).  This study of orthopedic, colorectal, gynecology, urology, neurological, other types of surgery, and vascular surgery performed by generalists was chosen because there are no subspecialty boards in these areas.  So an extension to pediatric anesthesia may be a stretch.  Nevertheless, they examined the outcomes based on 3 groups of anesthesia care teams: group one had both an experienced anesthesiologist and anesthetist, group 2 had either an experienced anesthesiologist or anesthetist and one inexperienced member, and a third group consisting of an inexperienced anesthesiologist and anesthetist. 

The results are eye-popping. “Anesthesia provided by experienced pairs of caregivers was associated with 40% decreased odds of having a composite of in-hospital morbidity and mortality compared to an inexperienced pair of caregivers. Furthermore, patients cared for by experienced pairs were less likely to experience bleeding complications, had fewer infections, shorter hospitalization, and less in-hospital mortality.”

There are many limitations to this study.  There were no subspecialty teams like neuro anesthesia or cardiac anesthesia included in this study, nor were single providers studied so extension to pediatric anesthesia is a stretch.  Further, the study only looked at daytime cases, not emergencies or night call cases. Finally, I must admit that the statistical methods used were way beyond me, so I’m relying on the editors of the journal for their expertise in validating the results.  Having said all of that, these results appear intuitive, namely that experience matters.  This should be a wake-up call for us because the role of experience has never really been studied in our subspecialty and I think it should be.  So this is a research area in want of a champion or champions.

What do you think?  

Myron Yaster MD