Cost impact of unexpected disposition after orthopedic ambulatory surgery associated with category of anesthesia provider

J Clin Anesth. 2016 Dec;35:157-162. doi: 10.1016/j.jclinane.2016.06.012. Epub 2016 Aug 17.


Study objective: To provide estimates of the costs and health outcomes implications of the excess risk of unexpected disposition for nurse anesthetist (NA) procedures.

Design: A projection model was used to apply estimates of costs and health outcomes associated with the excess risk of unexpected disposition for NAs reported in a recent study.

Setting: Ambulatory and inpatient surgery.

Patients: Base-case model parameters were based on estimates taken from peer-reviewed publications when available, or from other sources including data for all hospital stays in the United States in 2013 from the Healthcare Cost and Utilization Project Web site. The impact of parameter uncertainty was assessed using 1-way and 2-way sensitivity analyses.

Interventions: Not applicable.

Measurements: Major complication rates, relative risks of complications, anesthesia costs, costs of complications, and cost-effectiveness ratios.

Main results: In the base-case model, there were on average 2.3 fewer unexpected dispositions for physician anesthesiologists compared with NAs. Overall, anesthesia-related costs (including the cost of managing unexpected dispositions) were estimated to be about $31 higher per procedure for physician anesthesiologists compared with NAs. Alternative model scenarios in the sensitivity analysis produced estimates of smaller additional costs associated with physician anesthesia administration, to the point of cost savings in some scenarios.

Conclusions: Provision of anesthesia for ambulatory knee and shoulder procedures by physician anesthesiologists results in better health outcomes, at a reasonable additional cost, compared with procedures with NA-administered anesthesia, at least when using updated cost-effectiveness willingness-to-pay benchmarks.

Keywords: Ambulatory surgery; Cost-effectiveness; Disposition risk; Nurse anesthetists; Physician-administered anesthesia; Projection model.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Ambulatory Surgical Procedures / adverse effects
  • Ambulatory Surgical Procedures / economics*
  • Anesthesia / adverse effects
  • Anesthesia / economics*
  • Anesthesia / methods
  • Anesthesiologists / economics
  • Cost-Benefit Analysis*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Models, Statistical
  • Nurse Anesthetists / economics
  • Orthopedic Procedures / adverse effects
  • Orthopedic Procedures / economics*
  • Outcome Assessment, Health Care / economics*
  • Postoperative Complications / economics*
  • Postoperative Complications / epidemiology
  • Treatment Outcome
  • United States
  • Young Adult