American Society of Anesthesiologists: Study Shows Fewer Seniors' Deaths When Anesthesiologists Supervise Anesthesia Care

Jun 27, 2000, 01:00 ET from American Society of Anesthesiologists

    PARK RIDGE, Ill., June 27 /PRNewswire/ -- In light of new and compelling
 scientific data published today, the American Society of Anesthesiologists
 (ASA) is strengthening its efforts and appealing to the White House to
 intercede on behalf of senior citizens who are in danger of losing a major
 Medicare benefit, one that is critical to their safety during surgery.
      The new data comes from an unprecedented patient outcome study from the
 University of Pennsylvania, showing that Medicare patients are far safer if an
 anesthesiologist is involved in their anesthesia care.
     The study, authored by Jeffrey H. Silber, M.D., Ph.D., director of the
 Center for Outcomes Research at The Children's Hospital of Philadelphia,
 looked at 217,440 Medicare patients in Pennsylvania whose anesthesia care
 involved anesthesiologists and compared it to the outcomes of patients who
 received anesthesia without the involvement of an anesthesiologist.
     Dr. Silber's findings show that for every 10,000 patients who had surgery,
 there were 25 more deaths if an anesthesiologist did not direct the anesthesia
 care.  When complications arose and there was no anesthesiologist supervising,
 there were 69 patients for each 10,000 who did not survive during the 30-day
 period after their hospital admission.  The study, which included data from
 245 Pennsylvania hospitals, was published in the July issue of the medical
 journal Anesthesiology.
     "This long-awaited study comes to one inescapable conclusion -- patient
 deaths are greatly reduced when anesthesiologists are involved in the
 anesthesia care," ASA President Ronald A. MacKenzie, D.O., said.  "Yet
 Medicare is willing to allow anesthesia nurses to care for Medicare patients,
 not only without an anesthesiologist but without any doctor supervision.  That
 is not only dangerous, it is unconscionable."
     The release of this study comes at a time when the Health Care Financing
 Administration (HCFA), which oversees the Medicare program, is about to remove
 its 35-year-old rule requiring that physicians supervise patients' anesthesia
     "This study makes the point very clearly.  Patients are safer and have a
 better chance of surviving a complication if an anesthesiologist is directly
 involved in their anesthesia care," Dr. MacKenzie said.  "This should convince
 Medicare administrators, Capitol Hill lawmakers and the White House that
 allowing the Medicare rule change to go into effect would be disastrous to
 older patients having surgery."
     Furthermore, Dr. MacKenzie noted, "This proposal does not even save
 Medicare any money because HCFA reimburses anesthesia at the same rate,
 regardless of who provides the anesthetic."
     Dr. Silber's findings echo other patient outcome studies, some dating back
 more than 20 years.  The most frequently quoted data show that anesthesia
 patient safety has greatly improved from 1 in 10,000 anesthetics to 1 in
 250,000 today.  This figure is based on patient mishaps that occurred within
 24 hours of surgery for patients of different age groups, including the
 healthiest patients.  Dr. Silber's study, however, looked solely at Medicare
 patients and their status 30 days after the patient's hospitalization and
 found that risks for death and injury are considerably higher.
     "Why then would Medicare consider lessening that level of safety for our
 aging, often sickest patients, when we should be working to improve safety
 even more?" Dr. MacKenzie asked.
     Calls for HCFA to abandon its rule change are increasing each day.  All 50
 state medical associations plus those representing the District of Columbia,
 Puerto Rico and the U.S. Virgin Islands are asking Medicare to keep physician
 involvement in Medicare patients' anesthesia care unless it can be proven that
 the current level of patient safety will be maintained.  Concern has also come
 from more than 30 nonanesthesia medical specialty organizations, including the
 American Medical Association and the American College of Surgeons.  Most are
 surgical associations whose members know the safety and patient care value
 that anesthesiologists bring to the operating room everyday, Dr. MacKenzie
     The Administration's Office of Management and Budget is now reviewing the
 proposed rule change.
     "We are appealing to President Clinton and Vice President Gore to come
 forward now and do what is right for our nation's seniors," Dr. MacKenzie
 said.  "As this scientific study now demonstrates, it would be disastrous to
 remove the involvement of a doctor in anesthesia care."
     The American Society of Anesthesiologists (ASA) represents more than
 35,000 physicians dedicated to patient safety and quality medical care.
 Founded in 1905, ASA is a scientific and educational association of
 anesthesiologists that was organized to advance the practice of anesthesiology
 and to improve the quality of care of the anesthetized patient.  It is the
 largest organization of anesthesiologists in the world.

SOURCE American Society of Anesthesiologists