Study Shows Fewer Seniors' Die When Anesthesiologist is Involved in Care

    PARK RIDGE, Ill., June 27 -- 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 care.  

   "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 said.

     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.