Yes, It Matters Who Manages Sedation During Interventional Radiology Procedures

SAN FRANCISCO — Following interventional radiology procedures such as coronary angioplasty, patients were more likely to be discharged home, rather than to a nursing or long-term care facility, when sedation was provided by trained anesthesia specialists, a researcher said.

Odds of an “adverse discharge” were lower by 32% (OR 0.68, 95% CI 0.57-0.81) when anesthesia staff, such as an MD-type anesthesiologist or certified nurse anesthetist, were managing patient sedation versus professionals without specialized training, according to Annika Eyth, an MD/PhD candidate at Montefiore Medical Center in New York City.

The difference was maintained in a propensity-matched analysis, with an odds ratio of 0.65 (95% CI 0.54-0.79), Eyth said at a late-breaking abstract session at the American Society of Anesthesiologists annual meeting.

She noted that, with trained anesthesia providers in short supply nationwide, hospitals have turned to nonspecialists for providing sedation during minimally invasive procedures seen as relatively low-risk. Interventional radiology is one such situation, in which patients are catheterized or biopsied with imaging guidance.

Eyth and colleagues drew on patients’ records from 2016-2022 at Montefiore for the study. Those undergoing procedures related to stroke (which come with much higher likelihood of discharge to another facility) were excluded. Ultimately the group identified 9,682 eligible patients, of whom 1,809 had sedation given by a trained specialist.

Discharge to nursing or long-term care facilities was recorded for 18.2% of procedures in which anesthesia specialists were not present, versus 11.6% of those who did receive sedation from certified personnel.

In the propensity-matched analysis, the corresponding rates were 16.8% and 11.6%. This analysis took into account a host of factors including the presence of certain comorbidities, age, weight, procedural complexity, and year of procedure (to capture changes in clinical practice over time). Each of the 1,809 patients whose cases involved specialist anesthesia providers were matched as closely as possible with one getting sedation from a nonspecialist.

Eyth added that the presence of anesthesia staff was associated with a substantially higher rate of ICU admission: 4.8% versus 2.4% (P=0.0001). She said that this was probably because trained personnel were better able to recognize when patients were in serious difficulty, although it remained possible that specialists were preferentially assigned to cases already recognized as high-risk.

Notably, no advantage for trained anesthesia professionals was seen for procedures lasting an hour or less (OR 1.23, 95% CI 0.83-1.81). It was only for those with longer duration that outcomes were significantly improved with specialists’ presence. In general, the outcome gap was greatest for procedures classed as moderate risk.

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