In reply.

Anesthesiology (Impact Factor: 6.17). 03/2014; 120(3):782. DOI: 10.1097/ALN.0000000000000116
Source: PubMed
  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND:: Using Pennsylvania Medicare claims from 1995 to 1996, the authors previously reported that anesthesia procedure length appears longer in blacks than whites. In a new study using a different and larger data set, the authors now examine whether body mass index (BMI), not available in Medicare claims, explains this difference. The authors also examine the relative contributions of surgical and anesthesia times. METHODS:: The Obesity and Surgical Outcomes Study of 47 hospitals throughout Illinois, New York, and Texas abstracted chart information including BMI on elder Medicare patients (779 blacks and 14,596 whites) undergoing hip and knee replacement and repair, colectomy, and thoracotomy between 2002 and 2006. The authors matched all black Medicare patients to comparable whites and compared procedure lengths. RESULTS:: Mean BMI in the black and white populations was 30.24 and 28.96 kg/m, respectively (P < 0.0001). After matching on age, sex, procedure, comorbidities, hospital, and BMI, mean white BMI in the comparison group was 30.1 kg/m (P = 0.94). The typical matched pair difference (black-white) in anesthesia (induction to recovery room) procedure time was 7.0 min (P = 0.0019), of which 6 min reflected the surgical (cut-to-close) time difference (P = 0.0032). Within matched pairs, where the difference in procedure times was greater than 30 min between patients, blacks more commonly had longer procedure times (Odds = 1.39; P = 0.0008). CONCLUSIONS:: Controlling for patient characteristics, BMI, and hospital, elder black Medicare patients experienced slightly but significantly longer procedure length than their closely matched white controls. Procedure length difference was almost completely due to surgery, not anesthesia.
    Anesthesiology 05/2013; 119(1). DOI:10.1097/ALN.0b013e31829101de · 6.17 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Procedure time is a clinically important variable that is often analyzed when studying quality and efficiency. Norms for procedure length have not been reported from Medicare data sets, nor has the influence of patient and hospital characteristics on procedure time been estimated using Medicare data. The authors obtained Medicare claims on all patients aged 65-85 years who underwent general surgical and orthopedic surgical procedures in Pennsylvania. Anesthesia procedure time was estimated from anesthesia time units bills supplied from Medicare on 20 common general and orthopedic surgery procedures, and models to determine the influence of hospital and patient characteristics were developed. Of the 77,638 patients, 31,472 had general surgery and 46,166 underwent orthopedic procedures. The median anesthesia time for general surgery was 133 min, and for orthopedic surgery it was 146 min. After adjusting for principal procedure, hospital, and physiologic severity, covariates associated with increased anesthesia time included: multiple procedure on same day + 18.3 min (P < 0.0001); transfer-in + 6.7 min (P = 0.0002); black race + 5.5 (P < 0.0001); coagulation disorders + 4.9 (P = 0.0012); and paraplegia + 4.5 (P = 0.0006). Lower-income black patients had significantly longer procedure times than lower-income white patients (+ 7 min; P < 0.0001). Among the 15 hospitals with the largest black surgical populations, 5 hospitals had statistically significant procedure lengths for black versus white patients, ranging from + 9 to + 16 min. In addition to variation by patient comorbidities and procedure, anesthesia procedure time varies with hospital, medical history, and sociodemographic characteristics.
    Anesthesiology 02/2007; 106(2):356-64. DOI:10.1097/00000542-200702000-00025 · 6.17 Impact Factor