• Julie Hallet, Rinku Sutradhar, Antoine Eskander, François M Carrier, Daniel McIsaac, Alexis F Turgeon, d'EmpairePablo PerezPPDepartment of Anesthesiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada., Chris Idestrup, Alana Flexman, Gianni Lorello, Gail Darling, Biniam Kidane, Wing C Chan, Yosuf Kaliwal, Victoria Barabash, Natalie Coburn, and Angela Jerath.
• Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
• Ann. Surg. 2023 Oct 1; 278 (4): e820e826e820-e826.

ObjectiveExamine between-hospital and between-anesthesiologist variation in anesthesiology provider-volume (PV) and delivery of high-volume anesthesiology care.BackgroundBetter outcomes for anesthesiologists with higher PV of complex gastrointestinal cancer surgery have been reported. The factors linking anesthesiology practice and organization to volume are unknown.MethodsWe identified patients undergoing elective esophagectomy, hepatectomy, and pancreatectomy using linked administrative health data sets (2007-2018). Anesthesiology PV was the annual number of procedures done by the primary anesthesiologist in the 2 years before the index surgery. High-volume anesthesiology was PV>6 procedures/year. Funnel plots to described variation in anesthesiology PV and delivery of high-volume care. Hierarchical regression models examined between-anesthesiologist and between-hospital variation in delivery of high-volume care use with variance partition coefficients (VPCs) and median odds ratios (MORs).ResultsAmong 7893 patients cared for at 17 hospitals, funnel plots showed variation in anesthesiology PV (median ranging from 1.5, interquartile range: 1-2 to 11.5, interquartile range: 8-16) and delivery of HV care (ranging from 0% to 87%) across hospitals. After adjustment, 32% (VPC 0.32) and 16% (VPC: 0.16) of the variation were attributable to between-anesthesiologist and between-hospital differences, respectively. This translated to an anesthesiologist MOR of 4.81 (95% CI, 3.27-10.3) and hospital MOR of 3.04 (95% CI, 2.14-7.77).ConclusionsSubstantial variation in anesthesiology PV and delivery of high-volume anesthesiology care existed across hospitals. The anesthesiologist and the hospital were key determinants of the variation in high-volume anesthesiology care delivery. This suggests that targeting anesthesiology structures of care could reduce variation and improve delivery of high-volume anesthesiology care.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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