• Julie Hallet, Angela Jerath, Pablo Perez d'Empaire, Antoine Eskander, François M Carrier, Daniel I McIsaac, Alexis F Turgeon, Chris Idestrup, Alana M Flexman, Gianni Lorello, Gail Darling, Biniam Kidane, Yosuf Kaliwal, Victoria Barabash, Natalie Coburn, and Rinku Sutradhar.
• Department of Surgery, University of Toronto, Toronto, ON, Canada.
• Ann. Surg. 2023 Sep 1; 278 (3): e503e510e503-e510.

ObjectiveTo examine the association of between hospital rates of high-volume anesthesiology care and of postoperative major morbidity.BackgroundIndividual anesthesiology volume has been associated with individual patient outcomes for complex gastrointestinal cancer surgery. However, whether hospital-level anesthesiology care, where changes can be made, influences the outcomes of patients cared at this hospital is unknown.MethodsWe conducted a population-based retrospective cohort study of adults undergoing esophagectomy, pancreatectomy, or hepatectomy for cancer from 2007 to 2018. The exposure was hospital-level adjusted rate of high-volume anesthesiology care. The outcome was hospital-level adjusted rate of 90-day major morbidity (Clavien-Dindo grade 3-5). Scatterplots visualized the relationship between each hospital's adjusted rates of high-volume anesthesiology and major morbidity. Analyses at the hospital-year level examined the association with multivariable Poisson regression.ResultsFor 7893 patients at 17 hospitals, the rates of high-volume anesthesiology varied from 0% to 87.6%, and of major morbidity from 38.2% to 45.4%. The scatter plot revealed a weak inverse relationship between hospital rates of high-volume anesthesiology and of major morbidity (Pearson: -0.23). The adjusted hospital rate of high-volume anesthesiology was independently associated with the adjusted hospital rate of major morbidity (rate ratio: 0.96; 95% CI, 0.95-0.98; P <0.001 for each 10% increase in the high-volume rate).ConclusionsHospitals that provided high-volume anesthesiology care to a higher proportion of patients were associated with lower rates of 90-day major morbidity. For each additional 10% patients receiving care by a high-volume anesthesiologist at a given hospital, there was an associated reduction of 4% in that hospital's rate of major morbidity.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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