By: 11 November 2015
The contribution of the anaesthetist to risk-adjusted mortality after cardiac surgery

The contribution of the anaesthetist to risk-adjusted mortality after cardiac surgery

A study undertaken on behalf of the Association of Cardiothoracic Anaesthetists (ACTA) looked at survival after cardiac surgery of 110,000 patients over 10 years in 10 centres across the UK, and shows for the first time that death after heart surgery is determined overwhelmingly by patient risk factors, rather than by which professionals or which hospitals provide the care. Published in the journal Anaesthesia, the study found the major contributing factors to patient death are their underlying fitness and the presence of co-existing disease – these account for 96 per cent of the risk attributed to surgery.  It also quantified for the first time in a large multi-centre UK-wide study the contribution made by the anaesthetist to outcomes following cardiac surgery.

Death rates following cardiac surgery are low and consistently improving in the UK. The study showed a small amount of variability in surgical practice, which accounted for 4 per cent of the risk of death. However, once these risks were taken into account, there was no variability in anaesthetic practice amongst the 190 consultant anaesthetists studied, and the individual anaesthetist did not contribute to patient death following surgery.

This lack of variability in consultant cardiothoracic anaesthetist performance is tremendously reassuring. The implication of this research is that the many years of training and experience gained in the UK health system ensures that practice is uniform and does not unduly put patients at risk. The international anaesthetic community has been engaged in a discussion as to whether death following cardiac surgery should be attributed to the individual named anaesthetist and published, similar to the data publicly available for cardiac surgeons. On the basis of this work, the Association of Cardiothoracic Anaesthetists has concluded that collection and publication of outcome by named anaesthetist is not warranted.

Together with the excellent results of cardiac surgery in the UK, the findings of this study will be reassuring to patients and their families. Resources and research should now be targeted at improving the fitness of patients who need to undergo cardiac surgery.

This study is accompanied by an editorial that describes this study as one of the most important pieces of research in cardiac anaesthesia published in the last 30 years. It asks and answers a fundamental question: do anaesthetists contribute any harm to patients undergoing cardiac surgery as measured by mortality? The categorical answer is no, and this is a very important finding.