title: The impact of anesthesiologists on coronary artery bypass graft surgery outcomes.
abstract: BACKGROUND
  One of every 150 hospitalized patients experiences a lethal adverse event; nearly half of these events involves surgical patients. Although variations in surgeon performance and quality have been reported in the literature, less is known about the influence of anesthesiologists on outcomes after major surgery. Our goal of this study was to determine whether there is significant variation in outcomes between anesthesiologists after controlling for patient case mix and hospital quality.
  
  
  METHODS
  Using clinical data from the New York State Cardiac Surgery Reporting System, we conducted a retrospective observational study of 7920 patients undergoing isolated coronary artery bypass graft surgery. Multivariable logistic regression modeling was used to examine the variation in death or major complications (Q-wave myocardial infarction, renal failure, stroke) across anesthesiologists, controlling for patient demographics, severity of disease, comorbidities, and hospital quality.
  
  
  RESULTS
  Anesthesiologist performance was quantified using fixed-effects modeling. The variability across anesthesiologists was highly significant (P < 0.001). Patients managed by low-performance anesthesiologists (corresponding to the 25th percentile of the distribution of anesthesiologist risk-adjusted outcomes) experienced nearly twice the rate of death or serious complications (adjusted rate 3.33%; 95% confidence interval [CI], 3.09%-3.58%) as patients managed by high-performance anesthesiologists (corresponding to the 75th percentile) (adjusted rate 1.82%; 95% CI, 1.58%-2.10%). This performance gap was observed across all patient risk groups.
  
  
  CONCLUSIONS
  The rate of death or major complications among patients undergoing coronary artery bypass graft surgery varies markedly across anesthesiologists. These findings suggest that there may be opportunities to improve perioperative management to improve outcomes among high-risk surgical patients.
authors.affiliation: From the Departments of Anesthesiology and Public Health Sciences, University of Rochester School of Medicine, Rochester, New York; RAND Health, RAND, Boston, Massachusetts; F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland; School of Public Health, University at Albany, State University of New York, Albany, New York; Department of Anesthesiology and Critical Care, University of Pennsylvania Health System, Philadelphia, Pennsylvania; and Anesthesia Quality Institute, Park Ridge, Illinois.
authors.forename: Laurent G
authors.initials: LG
authors.lastname: Glance
authors.forename: Arthur L
authors.initials: AL
authors.lastname: Kellermann
authors.forename: Edward L
authors.initials: EL
authors.lastname: Hannan
authors.forename: Lee A
authors.initials: LA
authors.lastname: Fleisher
authors.forename: Michael P
authors.initials: MP
authors.lastname: Eaton
authors.forename: Richard P
authors.initials: RP
authors.lastname: Dutton
authors.forename: Stewart J
authors.initials: SJ
authors.lastname: Lustik
authors.forename: Yue
authors.initials: Y
authors.lastname: Li
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Dick
mesh_terms: D000368:Aged; D000758:Anesthesia / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D000776:Anesthesiology / Q000379:methods; D002983:Clinical Competence; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009518:New York; D016017:Odds Ratio; D010819:Physician's Role; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D000078329:Workforce