If you're serious about patient safety and the quality of anesthesia care, read "Surgical Mortality and Type of Anesthesia Provider," a study in the April American Association of Nurse Anesthetist (AANA) Journal. The authors' conclusion that the type of anesthesia provider does not affect surgical mortality in hospitals is simply unfounded, in large part because the data are scientifically unsound. Even if one were to take the data on face value, a more reasonable conclusion would be that general anesthesia with the direct participation or oversight of an anesthesiology doctor is the approach associated with the least surgical mortality.

The data are scientifically unsound for two reasons. Although the authors attempted to cull out patients with coexisting, serious acute conditions by analyzing only non-emergency procedures and also adjusted for certain risk factors, this does not rule out mortality resulting from comorbidities or surgical complications. The authors admit that "only a careful review of medical records to determine the actual causes of mortality and morbidity" could eliminate bias, and they also admit that deaths due to surgical complications are "far more frequent than those due to anesthesia complications."

In addition, the fact that these nonemergency procedures were performed in hospitals (rather than in freestanding surgical facilities) implies that at least some of the patients had potentially significant comorbidities. Practically speaking, surgeons and other physicians almost always prefer anesthesiology doctors to conduct or direct the anesthetic for more seriously ill patients, particularly when the physician or a family member is the patient. As someone in the trenches, I can testify that this sort of self-selection for anesthesiology physicians occurs on a daily basis across our country.

Even if one were to disregard the statistical shortcomings of the AANA study, the raw data suggest that sole CRNA care was associated with one more death for every 840 patients (or nearly 12 additional deaths for every 10,000 patients) than "team" anesthesia care in which an anesthesiologist directed or provided care. In fact, this interpretation is more in line with many similar investigations, which have clearly demonstrated that the absence of an anesthesiology physician leads to significantly higher patient mortality (as many as 25 excessive deaths per 10,000 cases) and poorer outcomes when intraoperative complications arise.

The American Society of Anesthesiology and its physician members have been at the forefront of patient safety and have presided over the anesthesia care team while the risks of anesthesia have continuously dropped during the last 30 years. Anesthesiology doctors will continue to strive to provide the safest care available to their patients and will never accept even one patient death if it can be prevented. Poor outcomes should never be reduced to a statistic in a study (especially when that statistic is not scientifically sound) - for that statistic represents someone's mother, father, son, daughter or life partner.