OS1-128
More Training = Sicker Patients: Pediatric Anesthesiologists Care for Younger and Sicker Children
1Falcinelli J, 1Taicher B, 2Pollard R, 1Greene N, 1Cooter M, 2Buhrman W, 1Aronson S, 1Stafford-Smith M, 1Raghunathan K
1Duke University Medical Center, Durham, NC, US; 2MEDNAX National Medical Group, Sunrise, FL, US
INTRODUCTION:
Children routinely undergoing surgery in community-based facilities may or may not be cared for by anesthesiologists with specialized pediatric training. When compared to anesthesiologists without this training, pediatric anesthesiologists have undergone a year of formal training in caring for critically ill children and those undergoing complicated operative procedures. We examined differences in the characteristics of anesthesiologists treating patients in a large community-based practice (with or without at least one additional year or equivalent of education in an ACGME-approved pediatric fellowship-training program).
METHODS:
Patient and hospital characteristics, surgical procedure (CPT codes), anesthetic approach, efficiency and quality indicators, and patient outcomes within 48-hours prospectively were collected from 233 anesthetizing locations across 19 facilities in 2 US states as part of the QuantumTM Clinical Navigation System between Jan 1, 2009, and Dec 31, 2014 for all patients less than 18 years old. Each patient’s anesthesiologist was classified as either having completed a pediatric anesthesia fellowship program (or equivalent) or not, and case-mix characteristics were compared. In a sensitivity analysis designed to account for differences due to type of surgery, we repeated the comparison in a subset of patients undergoing isolated tonsillectomy and adenoidectomy (T&A). Due to the size of the sample, in addition to reporting p-values of group difference tests, we used standardized mean differences (SMD) and considered differences significant if the SMD>0.1.
RESULTS:
Of 82,372 eligible pediatric patients cared for by 109 anesthesiologists, 56.7% were cared for by 20 subspecialty-trained pediatric anesthesiologists (18.3% of all anesthesiologists). While caring for comparable numbers of patients, fellowship trained providers encountered approximately five times more pediatric patients per year (mean 491.3 vs. 98.6 for non-fellowship anesthesiologists). These fellowship trained anesthesiologists were more likely to treat younger (median age 4 vs 6 for non-fellowship anesthesiologists) and sicker (higher ASA status, history of prematurity) patients. Pediatric anesthesiologists are also more likely to care for infants and neonates (20.2% of their cases vs 5.9% of cases for non-fellowship trained anesthesiologists), and overall subspecialty-trained practitioners cared for 82% of these patients. In sensitivity analysis restricted to 8,581 patients undergoing T&A, pediatric anesthesiologists remained far more likely to care for younger (median age 4 vs 5 for non-fellowship anesthesiologists) and sicker patients.
CONCLUSIONS:
In a large community-based practice across more than 200 anesthetizing locations, pediatric anesthesiologists were more likely to care for younger or sicker patients when compared with anesthesiologists who did not have equivalent fellowship training. A sensitivity analysis of T&A procedures suggests this was true even after adjusting for the type of procedure. The implications of treating patients with higher acuity of illness in terms of examining efficiency indicators, quality indicators, and patient outcomes deserves further exploration.
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