Tag: American Society of Anesthesiologists (ASA)

Opioid use disorder treatment associated with decreased risk of overdose after surgery, suggests first-of-its-kind study of over 4 million surgeries

Newswise — SAN FRANCISCO — Although people with opioid use disorder (OUD) are significantly more likely to overdose or have a complication after major surgery than those without the disorder, using medications for the treatment of OUD before surgery may eliminate that extra risk, suggests a large, first-of-its-kind study presented at the ANESTHESIOLOGY^®2023 annual meeting.

Patients with OUD who didn’t use an OUD medication (such as buprenorphine or methadone) were over four times more likely to overdose after having surgery, yet those who used evidence-based OUD medication before surgery were essentially at no greater risk than those who didn’t have OUD, according to the study. Taken orally, OUD medications reduce withdrawal and cravings and prevent opioids from producing the feeling of euphoria that drives addiction.

“We know that OUD treatments are very effective in helping to prevent relapse, overdose and death in nonsurgical patients, but our research is the first to show that they also may be remarkably effective in at-risk patients facing surgical stress and recovery pain that often is addressed with opioids,” said Anjali Dixit, M.D., MPH, a pediatric anesthesiologist at Stanford University, California. “This is helping us learn more about how to optimally treat OUD patients so that their surgical and post-surgical pain is well-controlled, while also making sure we are minimizing their risk of relapse and overdose.”

Researchers analyzed 4,030,032 surgeries performed between 2008 and 2020 from the Merative MarketScan Commercial Database, a nationwide sample of data from patients with both employer-sponsored and Medicare Advantage insurance. The analysis reviewed overdoses and other complications (such as OUD-related hospitalization or infection) that occurred in the three months after surgery for the 25 most common surgeries, including knee and hip replacement, hysterectomy and gallbladder removal.

Of the over 4 million surgeries, 26,827 were performed on patients who had a history of OUD, 9,699 (36%) of whom used OUD medications in the month before surgery and 17,128 (64%) who did not. OUD patients who did not use OUD medications were 4.2 times more likely to overdose or have an OUD-related infection or hospitalization than those who did not have the disorder, according to the study. OUD patients who used OUD medications did not experience a statistically different risk of opioid-related adverse events compared to those who did not have the disorder.

As many as 7.6 million people in the U.S. live with OUD, according to research, and that number continues to grow. Only 20% of people with OUD currently use OUD medications, said Dr. Dixit. She noted the number of people in the study who used OUD medications was likely higher, because they had access to commercial insurance and therefore, better access to care. The researchers also want to look at other populations such as those on Medicaid, because they may be sicker and have less access to care.

“The national efforts to increase access to OUD medications is good news for people with OUD, including those who need surgery,” said Dr. Dixit. “The next step is to determine if a particular medication or regimen is better than another.”

THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS

Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific professional society with more than 56,000 members organized to advance the medical practice of anesthesiology and secure its future. ASA is committed to ensuring anesthesiologists evaluate and supervise the medical care of all patients before, during and after surgery. ASA members also lead the care of critically ill patients in intensive care units, as well as treat pain in both acute and chronic settings.

For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about how anesthesiologists help ensure patient safety, visit asahq.org/MadeforThisMoment. Join the ANESTHESIOLOGY^® 2023 social conversation today. Like ASA on Facebook, follow ASALifeline on Twitter and use the hashtag #ANES23.

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October 15, 2023
Black and Hispanic patients much more likely to die after surgery than white patients

Newswise — SAN FRANCISCO — About 12,000 Black and Hispanic patients who died after surgery the past two decades may have lived if there were no racial and ethnic disparities among Americans having surgery, suggests a study of more than 1.5 million inpatient procedures presented at the ANESTHESIOLOGY® 2023 annual meeting. This estimate draws attention to the human toll of disparities in surgical outcomes, with Black patients being 42% more likely and Hispanic patients 21% more likely to die after surgery compared to white patients.

Unless efforts to narrow the racial and ethnic gap in surgical outcomes intensify, preventable deaths will continue among minority patients, the researchers said. The development of equity policies to address disparity gaps can make a difference, with even a 2% reduction in projected excess mortality rates among Black patients averting roughly 3,000 post-surgery deaths in the next decade, they determined.

“This study represents the first effort to move beyond merely documenting the ongoing disparities in surgical outcomes in the U.S. by quantifying the aggregate human toll of these disparities,” said Christian Mpody, M.D., Ph.D., MBA, lead author of the study and assistant professor of anesthesiology and pediatrics at The Ohio State University College of Medicine, Columbus. “We should not become used to reading statistics about people dying. It’s essential to remember that beyond the statistics, odds ratios and p-values, these are real people — brothers, sisters, mothers and fathers.”

“The findings bring to light the deaths that may have been preventable if people of various racial and ethnic backgrounds had comparable mortality rates to white patients,” he said. “That’s important for conveying the gravity of the issue to policymakers, health care professionals and the general public.”

Researchers analyzed the Nationwide Inpatient Sample data of more than a million surgical procedures performed at 7,740 U.S. hospitals between 2000 and 2020. They determined Black patients were 42% more likely than white patients to die within 30 days of surgery, driven by higher mortality in the Northeast (Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island and Vermont). Hispanic patients were 21% more likely than white patients to die within 30 days of surgery, driven by higher mortality in the West (Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington and Wyoming).

Although death rates declined for all groups over the 20-year period, the disparity gaps did not narrow over time. The study did not identify causes of death.

“It’s important to note that disparities in these regions do not necessarily mean that the surgical care is inferior. It may reflect overall population health and socioeconomic conditions,” said Dr. Mpody. “Our team is currently investigating the underlying causes of these regional variations.”

Dr. Mpody said the study didn’t assess the effectiveness of specific interventions or policies, noting that addressing the problem requires a three-pronged approach involving research, education and service. Suggested interventions by the authors include increasing investment in disparity research and incorporating race and racism lectures in medical and nursing school curricula. Health systems should: provide cultural competency training; focus on diversity in grand rounds; invest in patient education and health literacy; develop personalized medicine approaches that take into account individual patients’ needs and race-sensitive protocols; and increase the number of minority providers.

THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS

Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific professional society with more than 56,000 members organized to advance the medical practice of anesthesiology and secure its future. ASA is committed to ensuring anesthesiologists evaluate and supervise the medical care of all patients before, during and after surgery. ASA members also lead the care of critically ill patients in intensive care units, as well as treat pain in both acute and chronic settings.

For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about how anesthesiologists help ensure patient safety, visit asahq.org/MadeforThisMoment. Join the ANESTHESIOLOGY® 2023 social conversation today. Like ASA on Facebook, follow ASALifeline on Twitter and use the hashtag #ANES23.

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October 15, 2023
Anesthesiologist-led blood management programs save hospitals significant amounts of blood and reduce costs with same or better patient outcomes
Newswise — SAN FRANCISCO — Blood management programs that reduced or avoided transfusions saved a health system millions of dollars annually, with a return on investment of more than $7 for every dollar spent, while achieving the same or better outcomes, suggests research presented at the ANESTHESIOLOGY® 2023 annual meeting.

Over the past 10 years, the Johns Hopkins Health System established a comprehensive blood management program with two primary goals: 1) to reduce unnecessary transfusions across the five-hospital health system, and 2) to provide specialized care that avoids transfusions in patients who decline them. Together these efforts save blood and reduce costs, making more blood available for those who really need it, such as trauma patients. Transfusions are routinely used for emergencies and trauma, but also are needed in heart, transplant, hip or knee replacement, spine, vascular, liver and pancreatic surgery. Nonsurgical patients also need blood, for example those with cancer (leukemia, lymphoma), sickle cell anemia or gastrointestinal bleeding.

“Since we are always dealing with blood shortages, doing more with less is critically important,” said Steven M. Frank, M.D., lead author of the study and professor in the Department of Anesthesiology and Critical Care Medicine at Johns Hopkins Medicine, Baltimore. “We like to say that blood saves lives when you need it, but only increases risks and costs when you don’t. Our results showed that a comprehensive blood management program can substantially help the bottom line — for every dollar spent, we received $7.50 in return.”

Starting in 2012, two anesthesiologist-led, multidisciplinary blood management programs were run side by side.
- The Patient Blood Management Clinical Community program was designed to reduce unnecessary transfusions using several methods. The methods include evidence-based transfusion triggers, a “Why Give 2 When 1 Will Do?” single unit of blood transfusion campaign, and other anesthesiology-led before, during or after surgery measures of “keeping blood in the patient” such as using medications or intentionally lowering blood pressure to reduce bleeding and using smaller tubes to collect blood for lab tests. Over a 10-year period, the annual blood acquisition cost reduction was $2.9 million, a 10.9% decrease and a 9.6-fold return on investment.
- The Center for Bloodless Medicine and Surgery program was designed to avoid transfusions entirely for those who don’t accept them, primarily Jehovah’s Witness patients. The program brings in revenue by attracting patients who are often turned down by other hospitals. Over 10 years, the program brought in approximately $5 million a year (after subtracting the direct cost of care), representing a 6.6-fold return on investment.
Clinical outcomes such as infection, blood clots, kidney injury, heart attack or stroke were the same before and after the Patient Blood Management Clinical Community program was instituted. Clinical outcomes were the same or better for the Center for Bloodless Medicine and Surgery program, as the incidence of hospital-acquired infection was significantly lower when transfusions were avoided.

“By reducing unnecessary medical procedures, we are actually doing more with less and providing higher value care,” said Dr. Frank. “Since clinical outcomes are either the same or better while giving less blood, the patients benefit from reduced risks and costs.”

THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS

Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific professional society with more than 56,000 members organized to advance the medical practice of anesthesiology and secure its future. ASA is committed to ensuring anesthesiologists evaluate and supervise the medical care of all patients before, during and after surgery. ASA members also lead the care of critically ill patients in intensive care units, as well as treat pain in both acute and chronic settings.

For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about how anesthesiologists help ensure patient safety, visit asahq.org/MadeforThisMoment. Join the ANESTHESIOLOGY® 2023 social conversation today. Like ASA on Facebook, follow ASALifeline on Twitter and use the hashtag #ANES23.

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October 14, 2023
AI Pain Recognition System Could Help Detect Patients’ Pain Before, During and After Surgery

Newswise — SAN FRANCISCO — An automated pain recognition system using artificial intelligence (AI) holds promise as an unbiased method to detect pain in patients before, during and after surgery, according to research presented at the ANESTHESIOLOGY^® 2023 annual meeting.

Currently, subjective methods are used to assess pain, including the Visual Analog Scale (VAS) — where patients rate their own pain — and the Critical-Care Pain Observation Tool (CPOT) — where health care professionals rate the patient’s pain based on facial expression, body movement and muscle tension. The automated pain recognition system uses two forms of AI, computer vision (giving the computer “eyes”) and deep learning so it can interpret the visuals to assess patients’ pain.

“Traditional pain assessment tools can be influenced by racial and cultural biases, potentially resulting in poor pain management and worse health outcomes,” said Timothy Heintz, B.S., lead author of the study and a fourth-year medical student at the University of California San Diego. “Further, there is a gap in perioperative care due to the absence of continuous observable methods for pain detection. Our proof-of-concept AI model could help improve patient care through real-time, unbiased pain detection.”

Early recognition and effective treatment of pain have been shown to decrease the length of hospital stays and prevent long-term health conditions such as chronic pain, anxiety and depression.

Researchers provided the AI model 143,293 facial images from 115 pain episodes and 159 non-pain episodes in 69 patients who had a wide range of elective surgical procedures, from knee and hip replacements to complex heart surgeries. The researchers taught the computer by presenting it with each raw facial image and telling it whether or not it represented pain, and it began to identify patterns. Using heat maps, the researchers discerned that the computer focused on facial expressions and facial muscles in certain areas of the face, particularly the eyebrows, lips and nose. Once it was provided enough examples, it used the learned knowledge to make pain predictions. The AI-automated pain recognition system aligned with CPOT results 88% of the time and with VAS 66% of the time.

“The VAS is less accurate compared to CPOT because VAS is a subjective measurement that can be more heavily influenced by emotions and behaviors than CPOT might be,” said Heintz. “However, our models were able to predict VAS to some extent, indicating there are very subtle cues that the AI system can identify that humans cannot.”

If the findings are validated, this technology may be an additional tool physicians could use to improve patient care. For example, cameras could be mounted on the walls and ceilings of the surgical recovery room (post-anesthesia care unit) to assess patients’ pain — even those who are unconscious — by taking 15 images per second. This also would free up nurses and health professionals — who intermittently take time to assess the patient’s pain — to focus on other areas of care. The researchers plan to continue to incorporate other variables such as movement and sound into the model.

Concerns about privacy would need to be addressed to ensure patient images are kept private, but the system could eventually include other monitoring features, such as brain and muscle activity to assess unconscious patients, he said.

THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS

Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific professional society with more than 56,000 members organized to advance the medical practice of anesthesiology and secure its future. ASA is committed to ensuring anesthesiologists evaluate and supervise the medical care of all patients before, during and after surgery. ASA members also lead the care of critically ill patients in intensive care units, as well as treat pain in both acute and chronic settings.

For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about how anesthesiologists help ensure patient safety, visit asahq.org/MadeforThisMoment. Join the ANESTHESIOLOGY^® 2023 social conversation today. Like ASA on Facebook and follow ASALifeline on Twitter and use the hashtag #ANES23.

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October 14, 2023
More Patients Go Home Instead of to Long-Term-Care Facility When Sedation for Common Procedures Is Administered or Directed by Anesthesiologist

Newswise — SAN FRANCISCO — Patients who had common procedures performed outside of the operating room (OR) were more likely to go home instead of to a long-term care facility when they were discharged from the hospital if their sedation was administered or directed by an anesthesiologist, rather than by a physician who is not a trained anesthesiologist, according to a first-of-its-kind study presented at the ANESTHESIOLOGY^® 2023 annual meeting.

Patients who need catheters placed in a vein, angiograms (X-ray of the blood vessels), image-guided biopsies and many other procedures typically are treated in the interventional radiology (IR) suite instead of the OR and given sedation. Sedation is a type of anesthesia that relieves anxiety, controls pain and discomfort, and sometimes makes them fall asleep. One in 10 patients admitted to the hospital requires an IR procedure and many are at increased risk for complications due to health issues or having more complex procedures.

The study was the first to directly compare the hospital discharge outcomes of patients who received sedation administered by an anesthesiologist, or by a nurse anesthetist under the direction of an anesthesiologist, to the discharge outcomes of patients whose sedation was administered or directed by a physician who was not an anesthesiologist, such as a radiologist or cardiologist. Anesthesiologists are physicians who are experts in ensuring the safety and comfort of patients undergoing surgery and other procedures and are highly trained in critical care to manage medical emergencies if there is a complication.

“We focused on patients undergoing IR procedures as they often have health issues such as heart disease or diabetes and some of the procedures are high risk,” said Matthias Eikermann, M.D., Ph.D., senior author of the study and chair of the department of anesthesiology at Montefiore Medical Center, Bronx, New York. “We found anesthesiologists add value to patients undergoing interventional radiology procedures. That’s especially true for complex neurovascular procedures such as angiograms for the treatment of aneurysms or the creation of an arteriovenous (AV) fistula, a connection between an artery and a vein, for people on dialysis and those that typically take longer than an hour.”

In the study, 9,682 patients had sedation in the IR suite and 1,639 (16.93%) were discharged from the hospital to a long-term care facility (such as a nursing home) because of complications that they may be more likely to experience due to their disease. Anesthesiologists have the training to identify these complications early and address them.

Of those who were not discharged home, 1,429 (87%) had their sedation administered or directed by a physician who was not an anesthesiologist, often with the assistance of a nurse, and 210 (13%) had their sedation administered or directed by an anesthesiologist.

“The anesthesiologist is not just providing sedation, but life support for the patient during the entire procedure,” said Dr. Eikermann. “The difference in outcomes is because anesthesiologists are trained to identify early complications and treat them immediately. Physicians who are not anesthesiologists are not trained to do that.”

Anesthesiologists administered or directed sedation for higher-risk patients, such as those with more health issues or who had more invasive procedures. Despite being at higher risk, the patients who received sedation administered or directed by an anesthesiologist were nearly 70% more likely to be discharged home than those whose sedation was administered or directed by a physician who was not an anesthesiologist.

“Increasingly, high-risk patients are undergoing procedures outside of the OR,” said Vilma Joseph, M.D., MPH, FASA, co-author of the study and director of procedural sedation at Montefiore Medical Center. “The presence of physician anesthesiologists as part of the anesthesia care team model has been associated with improved outcomes.”

“Patients should know that they can ask for an anesthesiologist if they are concerned about excessive pain, anxiety or their safety during diagnostic procedures,” said Dr. Eikermann. “Our research suggests rethinking anesthesia assignments to ensure anesthesiologists provide sedation when patients are at higher risk due to their health or are having more complex, longer or more-invasive procedures.”

THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS

Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific professional society with more than 56,000 members organized to advance the medical practice of anesthesiology and secure its future. ASA is committed to ensuring anesthesiologists evaluate and supervise the medical care of all patients before, during and after surgery. ASA members also lead the care of critically ill patients in intensive care units, as well as treat pain in both acute and chronic settings.

For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about how anesthesiologists help ensure patient safety, visit asahq.org/MadeforThisMoment. Join the ANESTHESIOLOGY^® 2023 social conversation today. Like ASA on Facebook, follow ASALifeline on Twitter and use the hashtag #ANES23.

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October 14, 2023
American Society of Anesthesiologists honors Stanley W. Stead, M.D., MBA, FASA, with its Distinguished Service Award

Newswise — SAN FRANCISCO — The American Society of Anesthesiologists (ASA) today presented Stanley W. Stead, M.D., MBA, FASA, with its 2022 Distinguished Service Award in recognition of his enduring contributions to advancing patient-centered, physician-led health care, and his advocacy related to health care economics, including value-based care and equitable physician payment models. The award is the highest honor ASA bestows and is presented annually to a member who has transformed the specialty of anesthesiology.

A nationally recognized thought leader in health care economics, information technology and quality of care, Dr. Stead served as a professor and senior hospital executive for more than three decades. He recently retired from his positions as vice chair and professor of anesthesiology and perioperative medicine at the University of California, Los Angeles (UCLA), and senior executive director of strategic planning, utilization, perioperative services, capital planning and risk management at the University of California, Davis. He also recently retired from his role as president and founder of Stead Health Group, Inc., in Los Angeles.

Dr. Stead served as ASA’s vice president of professional affairs from 2013-18, where he made innumerable contributions, both within the Society and to the specialty more widely. Notably, he led ASA’s efforts in advancing value-based payment and population care models, and co-developed ASA’s Perioperative Surgical Home (PSH) model of care. He received ASA’s Excellence in Government Award in 2012 and Lifetime Achievement Award in Practice Management in 2019.

Dr. Stead has held numerous positions in the Society. In 1993, he created ASA’s CROSSWALK®, a guide for surgery and anesthesia Current Procedural Terminology (CPT ®) codes, for which he served as author and editor for 30 years. He chaired ASA’s Committee on Economics and ASA’s Section on Professional Practice. He also served on the ASA Board of Directors, as well as the Board of Directors of the Anesthesia Quality Institute, an ASA foundation.

“I cannot imagine a more deserving recipient of ASA’s highest honor,” said ASA President Michael W. Champeau, M.D., FAAP, FASA. “I’ve worked alongside Dr. Stead for over 30 years. The breadth and depth of his knowledge about the specialty and health care economics have made him an invaluable resource to anesthesiology and our members.”

In addition to his commitments to ASA, Dr. Stead is a national expert on medical coding and reimbursement, having served on the American Medical Association’s (AMA) CPT Panel and Relative Value System Update Committee, and author of AMA’s 2007 and 2008 References on Physician Quality Reporting Initiative. He received the California Society of Anesthesiologists’ Distinguished Service Award in 2019. He has published more than 120 articles and delivered more than 150 lectures and presentations worldwide on a variety of health care topics.

Dr. Stead received a Bachelor of Science in biochemistry, Doctor of Medicine degree and a Master of Business Administration from UCLA, where he also completed his anesthesiology residency and fellowship in cardiothoracic anesthesiology. He completed his surgery internship at Cedars-Sinai Medical Center in Los Angeles.

The Distinguished Service Award is presented annually for outstanding clinical, educational, or scientific achievement, contribution to the specialty and/or exemplary service to the Society. ASA’s House of Delegates establishes policies governing the selection of a recipient for the Distinguished Service Award.

THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS
Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific professional society with more than 56,000 members organized to advance the medical practice of anesthesiology and secure its future. ASA is committed to ensuring anesthesiologists evaluate and supervise the medical care of all patients before, during and after surgery. ASA members also lead the care of critically ill patients in intensive care units, as well as treat pain in both acute and chronic settings.

For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about how anesthesiologists help ensure patient safety, visit asahq.org/madeforthismoment. Join the ANESTHESIOLOGY® 2023 social conversation today. Like ASA on Facebook, follow ASALifeline on Twitter and use the hashtag #ANES23.

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October 14, 2023

Anesthesiologists Denounce Another Year of Medicare Payment Cuts, Urge Immediate Reforms

Newswise — The American Society of Anesthesiologists (ASA) condemned yet another year of cuts to Medicare payments for critically important anesthesia and pain medicine services. The proposed cuts, announced in the Centers for Medicare & Medicaid Services’ (CMS) 2024 Physician Fee Schedule (PFS), represent the fifth consecutive year of either a pay freeze or payment cut for the services anesthesiologists provide to their patients as shown in the table below. The CMS-proposed Medicare payment cuts will compound the financial strain anesthesia practices are already facing.

“Yet another year of Medicare payment cuts shows that the Medicare physician payment system is completely broken and unsustainable. A comprehensive overhaul of the Medicare payment system for physicians is long overdue,” said ASA President Michael W. Champeau, M.D., FAAP, FASA. “The Medicare payment rates are grossly inadequate due to egregious flaws in the government formula used to calculate physician payment rates. These inadequate payment rates, rising practice costs, and COVID-19 pandemic-related financial pressures seriously threaten physicians’ practice survival and patient access to care. Congress must act.”

Within the fee schedule, CMS has proposed an anesthesia conversion factor (CF) of $20.370, representing a decrease of 3.26% from the 2023 anesthesia CF of $21.1249. The 2024 proposed Resource-Based Relative Value Scale (RBRVS) CF is $ 32.7476. This represents a decrease of 3.36% from the 2023 CF of $33.8872. CMS established this decrease due to a statutorily mandated budget neutrality adjustment for changes in work relative value units (RVUs) and practice expense updates.

Anesthesia and Resource-Based Relative Value Scale (RBRVS) Conversion Factor Trends

	Anesthesia CF	% Change	RBRVS CF	% Change
2017	$22.0454	–	$35.8887	–
2018	$22.1887	0.7%	$35.9996	0.3%
2019	$22.2730	0.4%	$36.0391	0.1%
2020	$22.2016	-0.3%	$36.0896	0.1%
2021	$21.5600	-2.9%	$34.8931	-3.3%
2022	$21.5623	0.0%	$34.6062	-0.8%
2023	$21.1249	-2.0 %	$33.8872	-2.1%
2024*	$20.4370	-3.3%	$32.7476	3.4%

* CY 2024 Proposed CF

Each of these cuts compounds the financial hurt anesthesiologists and their practices are facing with Medicare payments. Although legislation passed in 2023 provided for a 1.25% update to the conversion factor for CY 2024, this is less than the 2.5% update Congress approved for CY 2023. Absent congressional action, new cuts will be effective January 1, 2024.

ASA is committed to advocating for changes to the broken Medicare payment system to ensure anesthesiologists and other pain medicine physicians are paid fairly for the services they provide to their patients. ASA has strongly endorsed a legislative effort – H.R. 2474, the Strengthening Medicare for Patients and Providers Act, that would provide an inflationary adjustment to Medicare payments so that compensation for physicians and other clinicians matches the rising cost of the health care services they are providing. ASA has also strongly encouraged Congress and policymakers to re-evaluate the flawed budget neutrality clauses of the PFS that greatly restrict payment increases and cause continued payment cuts for many critical health care services. ASA looks forward to advocating our position before Congress and in working with CMS and other government stakeholders on proposed solutions.

Finalized provisions will become effective on January 1, 2024.

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July 13, 2023

Anesthesiologists, including one who lost both sons to opioid overdose, crusade for over-the-counter naloxone access

Newswise — Physician anesthesiologist Bonnie Milas, M.D., experienced firsthand the power of naloxone – a drug that reverses opioid overdose – having used it to save her son when she found him unresponsive on the kitchen floor.

With drug overdose deaths hitting a tragic record high in 2021, she knows that anyone could find themselves in her shoes, often without access to naloxone. Although she ultimately lost both of her sons to drug overdoses, she was grateful naloxone gave them additional chances to heal from their addiction.

Dr. Milas, a clinical professor of anesthesiology and critical care medicine at the University of Pennsylvania in Philadelphia and a member of the American Society of Anesthesiologists’ (ASA) Committee on Trauma and Emergency Preparedness, is committed to reducing the stigma associated with opioid use disorder, saving lives from opioid overdoses with easy access to naloxone, and working to ensure others don’t experience her devastating loss.

Both Dr. Milas and ASA support the U.S. Food and Drug Administration (FDA) advisory panel’s recommendation to make naloxone available over the counter and are crusading to ensure that it receives full FDA approval. She and Michael W. Champeau, MD, FAAP, FASA, president of ASA, are available to talk about the importance of easy naloxone access, how to identify and respond to an opioid overdose, ASA’s REVIVEme initiative, and how physician anesthesiologists have a critical role in the fight against opioid overdoses.

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March 6, 2023
Additional anesthesiology residency positions may help hospitals save costs, address projected workforce shortages of anesthesia care professionals
Newswise — ORLANDO, Fla. — Expanding anesthesiology residency programs — even in the absence of federal funding — may help medical institutions save staffing costs and address projected shortages of anesthesia care professionals, suggests a first-of-its-kind study being presented at the American Society of Anesthesiologists’ ADVANCE 2023, the Anesthesiology Business Event.

In the wake of the COVID-19 pandemic, hospital expenses are rising as health care staff leave medicine and their positions are filled often using costly temporary workers or paying other staff members for overtime or extra shifts.

“There is a projected shortage of anesthesia care professionals in the next three to five years, and a third of the physician anesthesiologist workforce is older than 60¹,” said Lauren Nahouraii, M.D., lead author of the study and an anesthesiology and perioperative medicine resident physician at the University of Pittsburgh Medical Center. “Adding extra anesthesiology residency positions can help address the issue, and our research suggests it also may be cost effective for the institution.”

Physicians who graduate from medical school pursue residencies in their desired specialties at U.S. medical institutions through the Accreditation Council for Graduate Medical Education (ACGME). The federal government provides funds for those residencies, capping the positions available at each medical institution. While the U.S. Congress has made provisions for ACGME-qualified institutions to offer additional residency positions, they may not receive federal funding. Anesthesiology residency positions usually fill up every year. In the 2022 match, 1,182 medical students (44% of applicants) seeking an anesthesiology residency did not match, suggesting there aren’t enough positions, she said.

In the study, the researchers compared the cost of anesthesiology residents vs. nurse anesthetists, factoring in actual work hours and supervision ratios. They determined expanding the program to include more residents is financially beneficial as the cost per hour of clinical coverage for residents was $29.14, whereas paying nurse anesthetists to work overtime was $181.12 per hour of clinical coverage and paying nurse anesthetists to take on extra shifts was $255.31 per hour of clinical coverage. The researchers concluded that over three years, the addition of three residency positions resulted in a cost savings of between $440,000 and $730,000 for the first year, $840,000 and $1.4 million for the second year, and $1.2 million and $1.9 million for the third year. The analysis factored in the cost of those three additional residents, who weren’t supported by federal funding.

“While institutions gain greater financial benefit if they can obtain federal funding for their anesthesiology residencies, our findings suggest they might consider expanding their residency positions even if they do not receive that funding,” said Dr. Nahouraii. “Given our study may be the first investigation and description of these cost savings, adding anesthesiology residency positions may quickly catch on across anesthesiology departments, as long as they are committed to maintaining the integrity of the educational mission of residency training.”

THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS

Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 56,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring physician anesthesiologists evaluate and supervise the medical care of patients before, during and after surgery to provide the highest quality and safest care every patient deserves.

For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about the role physician anesthesiologists play in ensuring patient safety, visit asahq.org/MadeforThisMoment. Like ASA on Facebook, follow ASALifeline on Twitter.
1. https://www.aamc.org/data-reports/workforce/interactive-data/active-physicians-age-specialty-2021
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January 27, 2023
Incorrectly recorded anesthesia start times cost medical centers and anesthesia practices significant revenue

Newswise — ORLANDO, Fla. — Inaccurately recording the start of anesthesia care during a procedure is common and results in significant lost billing time for anesthesia practices and medical centers, suggests a study being presented at the American Society of Anesthesiologists’ ADVANCE 2023, the Anesthesiology Business Event.

The anesthesia start time (AST) must be documented from a computer logged into the electronic health record (EHR), and typically occurs once the patient is in the operating room (OR). However, the anesthesiologist meets with the patient prior to their arrival in the OR and begins tasks that are vital to the procedure — such as administering pre-medication and attaching monitors — and that time typically is not recorded. Depending on the patient and procedure, adding two to five minutes to the AST when logging it would account for the preparation and transit time, researchers say.

“These seemingly minor inaccuracies of recorded AST can cost medical centers and anesthesia practices hundreds of thousands of dollars in lost revenue,” said Nicholas Volpe Jr., M.D., MBA, lead author of the study and an anesthesiology resident physician at Northwestern University McGaw Medical Center, Chicago. “We suspect most anesthesiologists are unaware that they aren’t recording AST accurately. It’s not a result of negligence, but rather reflects that workflow hasn’t been optimized for accuracy.”

For the study, the researchers analyzed 40,312 procedures involving anesthesia — which occurred between November 1, 2021 and October 31, 2022 — at a single academic center. In 27,771 of the cases (68.74%), AST was recorded as starting once the patient was in the OR, without factoring in the preparation time. Using the national average charge for anesthesia time, the missing time translated to $638,671.57 in lost revenue for the year, the researchers determined.*

“Logging AST is one of the many new tasks that anesthesiologists learn when starting a new role,” said Dr. Volpe. “Transitioning from an internship to clinical anesthesia practice involves learning a significant amount of new information, and understanding the importance of an accurately recorded AST may seem like a relatively minor issue compared to important patient-care information.”

Several approaches could help address inaccurate AST documentation, including educating anesthesiologists on how to improve their AST recording practices and providing visual reminders such as signs in the OR, Dr. Volpe said. Also, an AST capture function could be built into the EHR mobile application so that AST can be noted by anesthesiologists on the way to the OR, or the EHR could automatically add two minutes to the AST log time, he said. The researchers plan to roll out some of those initiatives in the spring and determine if they are effective.

*The projected savings are theoretical and not linked to billing at the institution where the study was conducted.

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THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS

Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 56,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring physician anesthesiologists evaluate and supervise the medical care of patients before, during and after surgery to provide the highest quality and safest care every patient deserves.

For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about the role physician anesthesiologists play in ensuring patient safety, visit asahq.org/MadeforThisMoment. Like ASA on Facebook, follow ASALifeline on Twitter.

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January 27, 2023
Reducing anesthetics during surgery decreases greenhouse gases without affecting patient care, study shows
Newswise — ORLANDO, Fla. — Anesthesiologists can play a role in reducing the greenhouse gas emissions that contribute to global warming by decreasing the amount of anesthetic gas provided during procedures without compromising patient care, suggests new research being presented at the American Society of Anesthesiologists’ ADVANCE 2023, the Anesthesiology Business Event.

Inhaled anesthetics used during general anesthesia are estimated to be responsible for 0.01% to 0.10% of the total worldwide carbon dioxide equivalent emission. For example, an hour of surgery using the inhaled anesthetic desflurane is equivalent to driving up to 470 miles, according to one study.¹ Carbon dioxide is the primary greenhouse gas that traps heat in the Earth’s atmosphere, contributing to global warming.

“Global warming is affecting our daily life more and more, and the reduction of greenhouse gas emissions has become crucial,” said Mohamed Fayed, M.D., M.Sc., lead author of the study and senior anesthesia resident at Henry Ford Health in Detroit. “No matter how small each effect is, it will add up. As anesthesiologists, we can contribute significantly to this cause by making little changes in our daily practice — such as lowering the flow of anesthetic gas — without affecting patient care.”

While most general anesthesia procedures require high fresh gas flow (FGF) at the beginning and end of the procedure to achieve the desired effect quickly, it is safe and effective to lower the flow during the rest of the procedure, Dr. Fayed said. As part of the initiative to reduce FGF overall, the researchers educated anesthesiologists at their institution about the benefits of dialing down the anesthetic gas flow during the procedure, including through departmental presentations, newsletter articles, posters placed in work areas and emails. They also removed desflurane from their operating rooms because it produces the most significant carbon dioxide emissions from among the existing inhaled anesthetics.

In the study of more than 13,000 patients, the authors set a goal of an average FGF of 3 liters per minute (L/min) or less for procedures. In March 2021, prior to the intervention, authors determined that FGF was 5-6 L/min in many cases, and only 65% of cases achieved an FGF of3 L/min or less. By July 2021, they recorded an average FGF of 3 L/min or less in 93% of cases. The researchers now are aiming to reduce the FGF to less than 2 L/min throughout the system.

The initiative is part of a quality improvement project called the Multicenter Perioperative Outcome Group, which includes more than 60 anesthesia practices. The ultimate goal is to measure actual carbon footprints from anesthetic agent waste for each surgical case, Dr. Fayed noted, but that will require significant modifications and costs.

Provided through a mask, inhaled anesthetics such as desflurane, sevoflurane and isoflurane are given to patients during general anesthesia so that they are unconscious during a major operation, such as open-heart surgery. Another inhaled anesthetic, nitrous oxide, sometimes is given during childbirth or during dental procedures. Inhaled anesthetics are not used for patients who undergo sedation, which is typically used for minimally invasive procedures, such as colonoscopies. Nor is it used during regional anesthesia, which is used for childbirth or surgeries of the arm, leg or abdomen and numbs only part of the body with the patient remaining aware.

“For a long time, there was a notion that the greenhouse effect caused in health care settings was an inevitable and unavoidable cost of providing patient care,” said Dr. Fayed. “But we have learned that reducing anesthetic gas flow is one of the many ways health care can lessen its contribution to the global warming crisis, along with reducing waste, turning off lights and equipment when not in use and challenging practice habits, as long as they don’t compromise patient care.”

Masakatsu Nanamori, M.D., is the lead attending physician on the study.

THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS

Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 56,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring physician anesthesiologists evaluate and supervise the medical care of patients before, during and after surgery to provide the highest quality and safest care every patient deserves.

For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about the role physician anesthesiologists play in ensuring patient safety, visit asahq.org/MadeforThisMoment. Like ASA on Facebook, follow ASALifeline on Twitter.
1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3522493/#:~:text=Using%20desflurane%20for%201%20hour,driving%2C%20according%20to%20the%20study.&text=The%20optimal%20(lowest%20environmental%20impact,it%20would%20minimize%20anesthetic%20use
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January 27, 2023
Green eyeglasses reduce pain-related anxiety in fibromyalgia patients, study shows

Newswise — NEW ORLEANS — Wearing special green eyeglasses for several hours a day reduces pain-related anxiety and may help decrease the need for opioids to manage severe pain in fibromyalgia patients and possibly others who experience chronic pain, according to a study being presented at the ANESTHESIOLOGY® 2022 annual meeting.

“Our research found that certain wavelengths of green light stimulate the pathways in the brain that help manage pain,” said Padma Gulur, M.D., lead author of the study and executive vice chair of Duke Anesthesiology and Duke Health, Chapel Hill, North Carolina. “There is an urgent need for additional treatments to reduce the use of opioids among patients with fibromyalgia and other types of chronic pain, and green eyeglasses could provide an easy-to-use, non-drug option.”

Few alternatives to opioids — especially non-drug options — exist for patients with severe and chronic pain conditions such as fibromyalgia, which causes pain all over the body. Fibromyalgia affects about 4 million U.S. adults, according to the Centers for Disease Control and Prevention.

Pain and anxiety share similar biological mechanisms. Additionally, fear of pain exacerbates anxiety, often leading to increased opioid use, said Dr. Gulur.

The researchers studied 34 fibromyalgia patients who were randomized to wear various shades of eyeglasses four hours a day for two weeks: 10 patients wore blue eyeglasses, 12 wore clear eyeglasses and 12 wore green eyeglasses. Patients who wore green eyeglasses were four times more likely to have reduced anxiety than those in the other groups, which saw no reduction in anxiety.

“We found that although their pain scores remained the same, those who wore the green eyeglasses used fewer opioids, demonstrating that their pain was adequately controlled,” said Dr. Gulur. “We would recommend the green eyeglasses treatment for those with fibromyalgia and are studying patients with other chronic pain conditions to determine if it would be beneficial.”

The eyeglasses are specially formulated to filter a specific wavelength on the green light spectrum, said Dr. Gulur. She noted that most patients who wore the green eyeglasses reported feeling better and asked to keep wearing them.

THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS

Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 55,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring physician anesthesiologists evaluate and supervise the medical care of patients before, during and after surgery to provide the highest quality and safest care every patient deserves.

For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about the role physician anesthesiologists play in ensuring patient safety, visit asahq.org/MadeforThisMoment. Join the ANESTHESIOLOGY® 2022 social conversation today. Like ASA on Facebook, follow ASALifeline on Twitter and use the hashtag #ANES22.

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October 23, 2022
Cannabis use increases pain after surgery, study shows

Newswise — NEW ORLEANS — Adults who use cannabis have more pain after surgery than those who don’t use cannabis, according to a study presented at the ANESTHESIOLOGY® 2022 annual meeting.

“Cannabis is the most commonly used illicit drug in the United States and increasingly used as an alternative treatment for chronic pain, but there is limited data that shows how it affects patient outcomes after surgery,” said Elyad Ekrami, M.D., lead author of the study and clinical research fellow of the Outcomes Research Department at Cleveland Clinic’s Anesthesiology Institute. “Our study shows that adults who use cannabis are having more — not less — postoperative pain. Consequently, they have higher opioid consumption after surgery.”

Researchers analyzed the records of 34,521 adult patients — 1,681 of them cannabis users — who had elective surgeries at Cleveland Clinic from January 2010 to December 2020. The cannabis users had used the drug within 30 days before surgery, while the other patients had never used cannabis. The patients who used cannabis experienced 14% more pain during the first 24 hours after surgery compared to the patients who never used cannabis. Additionally, patients who used cannabis consumed 7% more opioids after surgery, which the authors note was not statistically significant, but is likely clinically relevant.

“The association between cannabis use, pain scores and opioid consumption has been reported before in smaller studies, but they’ve had conflicting results,” Dr. Ekrami added. “Our study has a much larger sample size and does not include patients with chronic pain diagnosis or those who received regional anesthesia, which would have seriously conflicted our results. Furthermore, our study groups were balanced by confounding factors including age, sex, tobacco and other illicit drug use, as well as depression and psychological disorders.”

Dr. Ekrami noted that additional research is needed to further define cannabis’ effects on surgical outcomes. “Physicians should consider that patients using cannabis may have more pain and require slightly higher doses of opioids after surgery, emphasizing the need to continue exploring a multimodal approach to post-surgical pain control,” he said.

THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS
Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 55,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring physician anesthesiologists evaluate and supervise the medical care of patients before, during and after surgery to provide the highest quality and safest care every patient deserves.

For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about the role physician anesthesiologists play in ensuring patient safety, visit asahq.org/madeforthismoment. Join the ANESTHESIOLOGY® 2022 social conversation today. Like ASA on Facebook, follow ASALifeline on Twitter and use the hashtag #ANES22.

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October 23, 2022
Systemic racism plays role in much higher maternal mortality rate among Black women

Newswise — NEW ORLEANS — Black women have a 53% increased risk of dying in the hospital during childbirth, no matter their income level, type of insurance or other social determinants of health, suggesting systemic racism seriously impacts maternal health, according to an 11-year analysis of more than 9 million deliveries in U.S. hospitals being presented at the ANESTHESIOLOGY® 2022 annual meeting.

“This study is the most up-to-date and extensive study — factoring in various states, insurance types, hospital types and income levels — to determine that the much higher maternal mortality rate among Black women often cannot be attributed to differences in health, income or access to care alone,” said Robert White, M.D., M.S., lead author of the study and assistant professor of anesthesiology at Weill Cornell Medicine, New York. “Clearly there’s a need for legislation to improve access to health care throughout pregnancy and improve funding among safety-net hospitals. But it’s also essential that hospitals train their employees to provide culturally appropriate care, offer translation services and conduct implicit bias association testing.”

Causes of maternal death include the development of blood clots, heart failure, postpartum hemorrhage (excessive blood loss) and pre-eclampsia (extremely high blood pressure). The U.S. maternal mortality rate of 17.3 deaths per 100,000 births is higher than any other developed nation, with a huge disparity gap between Black and white mothers. The Centers for Disease Control and Prevention defines maternal mortality as death during pregnancy, delivery or within one year of the end of the pregnancy. This study focused on maternal death during childbirth in a hospital.

The researchers analyzed 9.5 million deliveries occurring in hospitals between 2007 and 2018, based on State Inpatient Databases from California, Florida, Kentucky, Maryland, New York and Washington. Of those, 49,472 mothers (0.5%) died in the hospital or experienced injury to the heart, eyes, kidney, brain or other organ, including 0.8% of all Black women, 0.5% of all Hispanic women and 0.4% of all white women. The researchers determined that compared to white women, Black women had a 53% increased risk of dying in the hospital, even after adjusting for insurance type, hospital type, income and other societal factors. Hispanic women and white women had the same risk of dying in the hospital.

“Physician anesthesiologists are leaders in quality, safety and perioperative medicine and are working very hard to help decrease racial differences through science and implementation of protocols that treat everyone the same — with a focus on those who are worse off to achieve health equity,” said Dr. White. “We not only provide pain management during childbirth, but our training in critical and emergency care help us to proactively handle complications, prevent death and ensure the health and safety of the mother and baby.”

Anesthesiologists are working on standardizing practices, which help reduce disparities. For example, the Society for Obstetric Anesthesia and Perinatology (SOAP) developed a protocol for enhanced recovery after cesarean delivery focusing on pain relief, movement, maternal-infant bonding, decreased opioid use and shorter length of stay. Anesthesiologists also have played a key role in the Alliance for Innovation on Maternal Health (AIM), a national data-driven quality improvement effort. This includes the development of patient safety bundles — a collection of evidence-informed, best practices to be implemented in all care settings, for every patient, in each episode of care — to improve outcomes.

Additionally, anesthesiologists have participated in state maternal mortality review committees to determine trends and system issues that can be improved, helped coordinate care for high-risk maternal disease and placenta implantation disorders, and organized and led simulations for obstetrical (OB) hemorrhage. This is of particular importance since the maternal mortality rate from OB hemorrhage is higher in Black women. Anesthesiologists have devised algorithms using point of care ultrasound (POCUS) that are especially helpful during OB hemorrhage and can be quickly used when a woman does not have a pulse to determine if there is activity in the heart.

The research in the abstract presented at ANESTHESIOLOGY 2022 was supported by a Foundation for Anesthesia Education and Research (FAER) Mentored Research Training Grant [FAER Grant ID: MRTG-08-15-2021-White (Robert)].

THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS

Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 55,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring physician anesthesiologists evaluate and supervise the medical care of patients before, during and after surgery to provide the highest quality and safest care every patient deserves.

For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about the role physician anesthesiologists play in ensuring patient safety, visit asahq.org/MadeforThisMoment. Join the ANESTHESIOLOGY® 2022 social conversation today. Like ASA on Facebook, follow ASALifeline on Twitter and use the hashtag #ANES22.

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October 22, 2022
Opioid prescribing after surgery remains the same for seniors, but doses are lower, study shows

Newswise — NEW ORLEANS — Although there has been no decrease in the number of opioid prescriptions seniors receive after surgery, the doses of those prescriptions are lower, according to a study of more than a quarter million Canadian patients being presented at the ANESTHESIOLOGY® 2022 annual meeting.

“While it’s good news that the doses in opioid prescriptions are being reduced, the fact that the actual number of opioid prescriptions filled has remained the same shows there is still an opportunity for improvement,” said Naheed Jivraj, MBBS, MS, FRCPC, lead author of the study and a critical care medicine fellow at the University of Toronto, Ontario. “That’s particularly true for procedures associated with low postoperative pain that can be effectively controlled with non-opioid medications such as acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs).”

While opioids can be an important part of pain management after surgery, limiting their use, including by lowering the dose, is important since they can cause major side effects and lead to addiction, as well as a potentially deadly overdose.

To assess trends in filling pain prescriptions in the week after surgery, the researchers studied the records of 278,366 patients representing all adults in Ontario older than 65 who had one of 14 surgical procedures between 2013 and 2019. The surgical procedures in the study included: thyroid removal, appendix removal, hernia repair, laparoscopic or open removal of the gallbladder, removal of the prostate, open-heart surgery, laparoscopic or open colon removal, laparoscopic vaginal or abdominal hysterectomy, removal of the breast, hip replacement and knee replacement.

They identified an increase in patients filling non-opioid prescriptions (e.g., acetaminophen or NSAID) from 9% in 2013 to 28% in 2019. They found most patients also continued to receive a prescription that contained an opioid — 76% in 2013 and 75% in 2019. However, the dose of the opioid prescriptions decreased, from an average of 317 MME (morphine milligram equivalent) in 2013 to an average of 260 MME in 2019.

Most patients undergoing procedures such as removal of the appendix or thyroid can get pain relief from acetaminophen or an NSAID; however, few patients who had these procedures filled prescriptions for those non-opioid alternatives, researchers noted.

“Our study highlights how pain management practices are changing after surgery,” said Dr. Jivraj. “The increase in seniors filling non-opioid prescriptions and the lower opioid dose may reflect the development of surgery-specific prescribing guidelines and the increasing use of anesthesiologist-championed Enhanced Recovery After Surgery protocols and other programs that focus on improving patient outcomes.”

THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS

Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 55,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring physician anesthesiologists evaluate and supervise the medical care of patients before, during and after surgery to provide the highest quality and safest care every patient deserves.

For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about the role physician anesthesiologists play in ensuring patient safety, visit asahq.org/MadeforThisMoment. Join the ANESTHESIOLOGY® 2022 social conversation today. Like ASA on Facebook, follow ASALifeline on Twitter and use the hashtag #ANES22.

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October 22, 2022
Regular use of common cholesterol-lowering drug linked to reduction of COVID-19 severity, risk of death

NEW ORLEANS — Commonly used cholesterol-lowering statins may reduce the risk of death and severity of COVID-19 disease, suggests a study of more than 38,000 patients being presented at the ANESTHESIOLOGY® 2022 annual meeting.

“While there is no ‘magic bullet’ to help patients who are very ill with COVID-19, statins decrease inflammation, which may help reduce the severity of the disease,” said Ettore Crimi, M.D., MBA, lead author of the study and professor of anesthesiology and critical care medicine, University of Central Florida, Orlando. “Results of our study clearly showed regular statin use is associated with reduced risk of death and improved outcomes in hospitalized COVID-19 patients.”

The retrospective study is one of the most extensive of regular statin use in patients with COVID-19. Researchers analyzed the electronic medical records of 38,875 patients hospitalized for COVID-19 at 185 hospitals in the United States between Jan. 1 and Sept. 30, 2020. Of those patients, 30% regularly used statins to treat high cholesterol. Statin users had a 37% lower risk of dying from COVID-19 than those who didn’t use statins. In addition, regular statin users were significantly less likely to be discharged to hospice, be admitted to the intensive care unit (ICU) or develop blood clots. They also had shorter hospital stays and spent less time on a ventilator.

While COVID-19 itself causes inflammation, in some cases the immune system creates further inflammation by responding too aggressively to the infection. This extreme reaction causes much of the damage to the body, including difficulty breathing and damage to the lungs, kidneys, heart, brain and vascular system. The anti-inflammatory actions of statins “cool the process” so that the disease is not as severe, Dr. Crimi said.

One in four Americans over the age of 40 take statins to lower their cholesterol and reduce their risk of heart attack, stroke and other cardiovascular diseases, according to the American Heart Association, making them one of the most commonly prescribed drugs.

“This research illustrates the importance of evaluating medications that could be repurposed to help patients in ways other than their intended use,” said Dr. Crimi. “Our results suggest statins could be an additional cost-effective solution against COVID-19 disease severity and should be studied further.”

THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS

Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 55,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring physician anesthesiologists evaluate and supervise the medical care of patients before, during and after surgery to provide the highest quality and safest care every patient deserves.

For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about the role physician anesthesiologists play in ensuring patient safety, visit asahq.org/MadeforThisMoment. Join the ANESTHESIOLOGY® 2022 social conversation today. Like ASA on Facebook, follow ASALifeline on Twitter and use the hashtag #ANES22.

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October 22, 2022
Enhanced Recovery After Surgery program enables same-day hip and knee replacement surgeries during pandemic
Newswise — NEW ORLEANS — Adaptations to a program that helps ensure the best possible outcomes from surgery allowed eligible patients to receive their hip and knee replacement surgeries during the COVID-19 pandemic without spending the night in the hospital. The changes were so successful that they have been implemented permanently at the institution, according to a quality improvement study being presented at the ANESTHESIOLOGY® 2022 annual meeting.

Championed by physician anesthesiologists, Enhanced Recovery After Surgery (ERAS) programs ease the effects of surgery and fast-track patient recovery.

In 2019, Stony Brook Medicine in New York implemented an ERAS program for elective hip and knee replacement surgeries, with all patients spending at least one night in the hospital after the procedure. However, during the pandemic the team revised the ERAS program so that selective patients could have an outpatient procedure, meaning they didn’t spend the night in the hospital.

The new ERAS protocol included:
- Developing a highly selective screening process to identify patients who would be good candidates for same-day surgery (i.e., relatively healthy, highly motivated with a good home-support system).
- Using a shorter-acting spinal anesthetic.
- Hydrating patients before the procedure and restricting the fluids used during surgery.
- Minimizing the use of urinary catheters to prevent infection.
- Improving pain management by sending patients home on a non-opioid pain pump.
- Providing home follow-up, including visits by nurses and physical therapists.
“We found for many patients, same-day surgeries are a safe alternative to an extended hospital stay,” said Sunitha Singh, M.D., lead author of the quality improvement project and coordinator for the ERAS program at Stony Brook Medicine. “Education, prehabilitation and patient engagement are critical to the recovery process. Patients often feel more rested recovering at home in familiar surroundings, and we have made the ERAS changes permanent due to the high success.”

Elective surgeries at Stony Brook Medicine were stopped during the peak of the pandemic (April-May 2020). The hospital implemented the new ERAS protocol beginning in June 2020 to provide continuity of care.

Over a one-year period, 152 patients had knee or hip replacement under the new program. Compared to patients who had the traditional ERAS protocol, patients in the new ERAS program stayed in the hospital an average of eight hours vs. an average of 1.7 days. No readmissions were reported. Currently, about 40% of the hospital’s hip and knee replacement patients participate in the same-day surgery ERAS program.

“Our findings demonstrate the adaptability of our health care system — including leveraging ERAS programs to respond to health care emergencies — while improving the quality of care,” Dr. Singh said.

THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS

Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 55,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring physician anesthesiologists evaluate and supervise the medical care of patients before, during and after surgery to provide the highest quality and safest care every patient deserves.

For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about the role physician anesthesiologists play in ensuring patient safety, visit asahq.org/MadeforThisMoment. Join the ANESTHESIOLOGY® 2022 social conversation today. Like ASA on Facebook, follow ASALifeline on Twitter and use the hashtag #ANES22.

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October 22, 2022
Opioid abuse decreases during pandemic, yet higher rates persist for sexual minorities

Newswise — NEW ORLEANS — Although opioid abuse in the U.S. is trending downward overall, it remains higher among non-heterosexuals than heterosexuals, according to an analysis of national survey data being presented at the ANESTHESIOLOGY® 2022 annual meeting.

“This is the first analysis to look at the status of opioid abuse during COVID-19 in this population,” said Mario Moric, M.S., lead author of the research and a biostatistician at Rush University Medical Center, Chicago. “We thought the pandemic would prompt a spike in opioid abuse, but we are happy that this was not the case. However, the higher level of abuse among sexual minorities compared to heterosexuals is a concern. It underscores the need to focus on the risk factors and formulate strategies to reduce opioid abuse in this vulnerable population.”

The researchers analyzed data collected through the annual National Survey on Drug Use and Health, which provides estimates of the prevalence of alcohol and drug use in the United States. More than 89,000 survey participants self-reported their sexual identity as heterosexual, homosexual or bisexual. The authors determined opioid abuse decreased between 2019 and 2020 among all three groups: from 3.5% to 3.2% for heterosexuals; 7.4% to 4.6% for homosexuals; and 10.3% to 7.6% for bisexuals. Overall, opioid abuse among adults 18 and older, regardless of sexual identity, declined by nearly 1 million, from 8 million adults in 2019 to 7.1 million adults in 2020.

While opioid abuse went down, drug overdose deaths rose to an all-time high during the pandemic, according to the Centers for Disease Control and Prevention.

“We need to conduct more research to understand exactly why overdose deaths spiked during the pandemic,” Moric said. “It’s important to understand that our analysis measured the incidence of opioid abuse, and not the amount of consumption. It could be that while casual abuse declined, patients who tend to abuse opioids in higher amounts and more frequently used them at an even higher rate during the stress of the pandemic, increasing the rate of overdose deaths.”

This analysis opens the door for future research to focus on identifying possible risk factors for these groups that will lead the development of programs aimed at reducing opioid abuse, the researchers noted. It also provides care teams with important insights that can impact their approach to treating vulnerable patient populations.

“Clinicians need to be aware of the higher likelihood of recreational use of opioids among sexual minorities compared to non-LGBTQ populations,” Moric added. “With greater awareness of these disparities, we can foster a more compassionate understanding of these patients and provide the most appropriate care and education to address the issue and reduce the stigma.”

THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS

Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 55,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring physician anesthesiologists evaluate and supervise the medical care of patients before, during and after surgery to provide the highest quality and safest care every patient deserves.

For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about the role physician anesthesiologists play in ensuring patient safety, visit asahq.org/MadeforThisMoment. Join the ANESTHESIOLOGY® 2022 social conversation today. Like ASA on Facebook, follow ASALifeline on Twitter and use the hashtag #ANES22.

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American Society of Anesthesiologists (ASA)

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October 22, 2022