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Physician anaesthetists versus non-physician providers of anaesthesia for surgical patients

  1. Sharon R Lewis1,*,
  2. Amanda Nicholson2,
  3. Andrew F Smith3,
  4. Phil Alderson4

Editorial Group: Cochrane Anaesthesia, Critical and Emergency Care Group

Published Online: 11 JUL 2014

Assessed as up-to-date: 13 FEB 2014

DOI: 10.1002/14651858.CD010357.pub2


How to Cite

Lewis SR, Nicholson A, Smith AF, Alderson P. Physician anaesthetists versus non-physician providers of anaesthesia for surgical patients. Cochrane Database of Systematic Reviews 2014, Issue 7. Art. No.: CD010357. DOI: 10.1002/14651858.CD010357.pub2.

Author Information

  1. 1

    Royal Lancaster Infirmary, Patient Safety Research, Lancaster, UK

  2. 2

    University of Liverpool, Liverpool Reviews and Implementation Group, Liverpool, UK

  3. 3

    Royal Lancaster Infirmary, Department of Anaesthetics, Lancaster, Lancashire, UK

  4. 4

    National Institute for Health and Care Excellence, Manchester, UK

*Sharon R Lewis, Patient Safety Research, Royal Lancaster Infirmary, Pointer Court 1, Ashton Road, Lancaster, LA1 1RP, UK. Sharon.Lewis@mbht.nhs.uk. sharonrlewis@googlemail.com.

Publication History

  1. Publication Status: New
  2. Published Online: 11 JUL 2014

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References

References to studies included in this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to studies awaiting assessment
  4. Additional references
  5. References to other published versions of this review
Dulisse 2010 {published data only}
  • Dulisse B, Cromwell J. No harm found when nurse anesthetists work without supervision by physicians. Health Affairs 2010; Vol. 29, issue 8:1469-75. [20679649]
Needleman 2009 {published data only}
  • Needleman J, Minnick AF. Anesthesia provider model, hospital resources, and maternal outcomes. Health Services Research 2009; Vol. 44, issue 2 Pt 1:464-82. [19178582]
Pine 2003 {published data only}
  • Pine M, Holt KD, Lou Y. Surgical mortality and type of anesthesia provider. AANA Journal 2003; Vol. 71, issue 2:109-16. [PUBMED: 12776638]
Rosseel 2010 {published data only}
  • Rosseel P, Trelles M, Guilavogui S, Ford N, Chu K. Ten years of experience training non-physician anesthesia providers in Haiti. World Journal of Surgery 2010; Vol. 34, issue 3:453-8. [19655194]
Silber 2000a {published data only}
Simonson 2007 {published data only}
  • Simonson DC, Ahern MM, Hendryx MS. Anesthesia staffing and anesthetic complications during cesarean delivery: A retrospective analysis. Nursing Research 2007; Vol. 56, issue 1:9-17. [17179869]

References to studies excluded from this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to studies awaiting assessment
  4. Additional references
  5. References to other published versions of this review
Abouleish 2004 {published data only}
  • Abouleish AE, Prough DS, Vadhera RB. Influence of the type of anesthesia provider on costs of labor analgesia to the Texas Medicaid Program. Anesthesiology 2004; Vol. 101, issue 4:991-8. [2004415389]
Charuluxananan 2005 {published data only}
  • Charuluxananan S, Punjasawadwong Y, Suraseranivongse S, Srisawasdi S, Kyokong O, Chinachoti T, et al. The Thai Anesthesia Incidents Study (THAI Study) of anesthetic outcomes: II anesthetic profiles and adverse events. Journal of the Medical Association of Thailand 2005; Vol. 88 Suppl 7:S14-29. [2006059623]
Charuluxananan 2008 {published data only}
  • Charuluxananan S, Thienthong S, Rungreungvanich M, Chanchayanon T, Chinachoti T, Kyokong O, et al. Cardiac arrest after spinal anesthesia in Thailand: a prospective multicenter registry of 40,271 anesthetics. Anesthesia and Analgesia 2008; Vol. 107, issue 5:1735-41. [18931240]
Faponle 2004 {published data only}
  • Faponle AF, Sowande OA, Adejuyigbe O. Anaesthesia for neonatal surgical emergencies in a semi-urban hospital, Nigeria. East African Medical Journal 2004; Vol. 81, issue 11:568-73. [15868965]
Fleming 1992 {published data only}
  • Fleming ST. Outcomes of care for anesthesia services: a pilot study. Quality Assurance in Health Care 1992; Vol. 4, issue 4:289-303. [1489965]
Hoffmann 2002 {published data only}
  • Hoffmann KK, Kevin Thompson G, Burke BL, Derkay CS. Anesthetic complications of tympanostomy tube placement in children. Archives of Otolaryngology - Head and Neck Surgery 2002; Vol. 128, issue 9:1040-3. [2002328374]
Leonard 2012 {published data only}
  • Leonard M, Jenkins A, Massey S, Chinyimba A, McColl S, Power D, et al. A review of non-physician delivered upper limb regional anaesthetic blocks at a tertiary referral hand centre. Regional Anesthesia and Pain Medicine 2012; Vol. 1:E289. [70881185]
Maaløe 2000 {unpublished data only}
  • Maaløe R. Incidents in relation to anaesthesia. A PhD thesis. University of Copenhagen 2000.

References to studies awaiting assessment

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to studies awaiting assessment
  4. Additional references
  5. References to other published versions of this review
Carpentier 2000 {published data only}
  • Carpentier JP, Banos JP, Brau R, Malgras G, Boye P, Dubicq J, et al. Practice and complications of spinal anaesthesia in African tropical countries. [French]. Annales Francaises d'Anesthesie et de Reanimation 2001; Vol. 20, issue 1:16-22. [2001063603]
DePaolis-Lutzo 1995 {published data only}
  • DePaolis-Lutzo M. Nurse anesthetists: a wise choice in today's health care system. American Nurse 1995; Vol. 27, issue 5:20. [PUBMED: 7653905]
Ezedigboh 1999 {published data only}
  • Ezedigboh IY. The nurse anaesthetist and health care delivery in the West African Subregion: a review covering 1991 to 1996. West African Journal of Nursing 1999; Vol. 10, issue 2:93-5. [2000021204.: Language: English. Entry Date: 20000301. Revision Date: 20091218. Publication Type: journal article]
Gadir 2007 {published data only}
  • Gadir ETA, Salama AA. The impact of anaesthetic assistants on anaesthesia service in Sudan. Internet Journal of Health 2007; Vol. 6, issue 2:12p. [2009926092.: Language: English. Entry Date: 20080613. Revision Date: 20110107. Publication Type: journal article]
Goldman 1988 {published data only}
  • Goldman HS. Anesthetic mistakes, mishaps, and misadventures. Current Reviews for Nurse Anesthetists 1988; Vol. 10, issue 20:155-60. [1989087382.: Language: English. Entry Date: 19890301. Publication Type: journal article]
MacKenzie 2000 {published data only}
  • MacKenzie RA. Nurse anesthetist: advantages and pitfalls. Acta Anaesthesiologica Belgica 2000; Vol. 51, issue 4:239-43. [11129627]

Additional references

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to studies awaiting assessment
  4. Additional references
  5. References to other published versions of this review
AAGBI 2010
  • The Association of Anaesthetists of Great Britain and Ireland. The Anaesthesia Team 2010. http://www.aagbi.org/ (accessed 4 December 2012).
AANA
  • American Association of Nurse Anesthetists. http://www.aana.com/ (accessed 26 March 2014).
ABA
  • The American Board of Anesthesiology. http://www.theaba.org/ (accessed 26 March 2014).
AHRQ
  • Agency for Healthcare Research and Quality. AHRQ quality indicators - guide to inpatient quality indicators: Quality of care in hospitals - Volume, mortality, and utilization, Revision 4 (22 December 2004).
Bacon 2002
  • Bacon DR, Lema MJ. Anaesthetic team and the role of nurses--North American perspective. Best Practice and Research. Clinical Anaesthesiology. 2002/12/21 2002; Vol. 16, issue 3:401-8. [PUBMED: 12491741]
Deeks 2003
  • Deeks JJ, Dinnes J, D'Amico R, Sowden AJ, Sakarovitch C, Song F, et al. Evaluating non-randomised intervention studies. Health Technology Assessment 2003;7:27. [PUBMED: 14499048]
Dubowitz 2010
  • Dubowitz G, Detlefs S, McQueen KA. Global anesthesia workforce crisis: a preliminary survey revealing shortages contributing to undesirable outcomes and unsafe practices. World Journal of Surgery. 2009/10/02 2010; Vol. 34, issue 3:438-44. [PUBMED: 19795163]
Egger 2006
  • Egger Halbeis CB, Macario A. Factors affecting supply and demand of anesthesiologists in Western Europe. Current Opinion in Anaesthesiology. 2006/03/23 2006; Vol. 19, issue 2:207-12. [PUBMED: 16552229]
Egger 2007
  • Egger Halbeis CB, Cvachovec K, Scherpereel P, Mellin-Olsen J, Drobnik L, Sondore A. Anaesthesia workforce in Europe. European Journal of Anaesthesiology. 2007/07/05 2007; Vol. 24, issue 12:991-1007. [PUBMED: 17608964]
Gardner 2011
  • Gardner MR, Posmontier B, Conti ME. The evolution of Advanced Practice Nursing Roles. Chapter 3. In: Dreher HM, Smith Glasgow ME editor(s). Role Development for Doctoral Advanced Nursing Practice. Springer Publishing Company, 2011.
Higgins 2011
  • Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane-handbook.org.
Jordan 2011
  • Jordan L. Studies support removing CRNA supervision rule to maximize anesthesia workforce and ensure patient access to care. AANA Journal 2011;79(2):101-4. [PUBMED: 21560971]
Kalist 2011
  • Kalist DE, Molinari NA, Spurr SJ. Cooperation and conflict between very similar occupations: the case of anesthesia. Health Economics, Policy, and Law. 2010/06/26 2011; Vol. 6, issue 2:237-64. [PUBMED: 20576190]
Kane 2004
  • Kane M, Smith AF. An American tale - professional conflicts in anaesthesia in the United States: implications for the United Kingdom. Anaesthesia. 2004/07/24 2004; Vol. 59, issue 8:793-802. [15270972]
Kane 2005
  • Kane M, Smith A, Milne R. Exploring professional boundaries in anaesthetics. Report for the National Co-ordinating Centre for NHS Service Delivery and Organisation R & D (NCCSCO) 2005.
Matsusaki 2011
  • Matsusaki T, Sakai T. The role of certified registered nurse anesthetists in the United States. Journal of Anesthesia. 2011/07/01 2011; Vol. 25, issue 5:734-40. [PUBMED: 21717163]
McKee 1999
  • McKee M, Coles J, James P. 'Failure to rescue' as a measure of quality of hospital care: the limitations of secondary diagnosis coding in English hospital data. Journal of Public Health Medicine 1999;21(4):453-8. [PUBMED: 11469370]
Medicare Policy 2005
  • Medicare Advantage Medical Policy. Medical direction (supervision) of Anesthesia. http://www.medicare.gov (Accessed 4 December 2012) Vol. A-3, 1 August 2005.
Meeusen 2010
  • Meeusen V, van Zundert A, Hoekman J, Kumar C, Rawal N, Knape H. Composition of the anaesthesia team: a European survey. European Journal of Anaesthesiology 2010; Vol. 27, issue 9:773-9. [PUBMED: 20671555]
Minnick 2008
  • Minnick AF, Needleman J. Methodological issues in explaining maternal outcomes: Anesthesia provider characterizations and resource variation. Western Journal of Nursing Research 2008; Vol. 30, issue 7:801-16. [18174374]
Needleman 2010
  • Needleman J, Minnick AF. Response to Commentary: What Conclusions Can We Draw from Recent Analyses of Anesthesia Provider Model and Patient Outcomes?. Health Services Research. Blackwell Publishing Inc, 2010; Vol. 45, issue 5p1:1397-406.
Neuman 2010
  • Neuman MD, Schwartz JS, Fleisher LA. Commentary: What conclusions can we draw from recent analyses of anesthesia provider model and patient outcomes?. Health Services Research 2010; Vol. 45, issue 5 Part 1:1390-6. [2010498454]
Newton 2010
  • Newton M, Bird P. Impact of parallel anesthesia and surgical provider training in sub-Saharan Africa: a model for a resource-poor setting. World Journal of Surgery. 2009/09/04 2010; Vol. 34, issue 3:445-52. [PUBMED: 19727934]
RevMan 5.1 [Computer program]
  • Copenhagen. Review Manager (RevMan). Version 5.1. The Nordic Cochrane Centre, The Cochrane Collaboration: Copenhagen, 2011.
Silber 2000b
  • Silber JH. Anesthesiologist direction and patient outcomes. LDI Issue Brief 2000; Vol. 6, issue 2:1-4. [12524701]
Smith 1997
Smith 2004
  • Smith AF, Kane M, Milne R. Comparative effectiveness and safety of physician and nurse anaesthetists: a narrative systematic review. British Journal of Anaesthesia 2004;93(4):540-5. [PUBMED: 15298878]
Smith 2005
  • Smith AF. Anaesthetic practitioners in the UK: promise, perils and psychology. Anaesthesia. 2005/10/19 2005; Vol. 60, issue 11:1055-8. [PUBMED: 16229687]
UK Contributors' Meeting 2012
  • The Cochrane Collaboration UK Contributors' Meeting. Loughborough, UK. March 2012. Non-randomised Studies Methods Group.
Vickers 2002
  • Vickers MD. Anaesthetic team and the role of nurses--European perspective. Best Practice & Research. Clinical Anaesthesiology. 2002/12/21 2002; Vol. 16, issue 3:409-21. [PUBMED: 12491742]
Walker 2007
Wilkinson 2007
  • Wilkinson D. Non-physician anaesthesia in the UK: a history. Journal of Perioperative Practice. 2007/05/08 2007; Vol. 17, issue 4:162, 164-6, 168-70. [PUBMED: 17479814]

References to other published versions of this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to studies awaiting assessment
  4. Additional references
  5. References to other published versions of this review
Lewis 2013
  • Lewis SR, Nicholson A, Smith AF. Physician anaesthetists versus non-physician providers of anaesthesia for surgical patients. Cochrane Database of Systematic Reviews 2013, Issue 2. [DOI: 10.1002/14651858.CD010357]