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Anesthesia Staffing and Anesthetic Complications During Cesarean Delivery: A Retrospective Analysis

Simonson, Daniel C.; Ahern, Melissa M.; Hendryx, Michael S.


Background: Obstetrical anesthesia services may be provided by Certified Registered Nurse Anesthetists (CRNAs), anesthesiologists, or a combination of the two providers. Research is needed to assist hospitals and anesthesia groups in making cost-effective staffing choices.

Objectives: To identify differences in the rates of anesthetic complications in hospitals whose obstetrical anesthesia is provided solely by CRNAs compared to hospitals with only anesthesiologists.

Methods: Washington State hospital discharge data were obtained from 1993 to 2004 for all cesarean sections, and were merged with a survey of hospital obstetrical anesthesia staffing. Anesthetic complications were identified via International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes. Resulting rates were risk-adjusted using regression analysis.

Results: Hospitals with CRNA-only staffing had a lower rate of anesthetic complications than those with anesthesiologist staffing (0.58% vs. 0.76%, p =.0006). However, after regression analysis, this difference was not significant (odds ratio for CRNA vs. anesthesiologist complications: 1.046 to 1, 95% confidence interval 0.649-1.658, p =.85).

Discussion: There is no difference in rates of complications between the two types of staffing models. As a result, hospitals and anesthesiology groups may safely examine other variables, such as provider availability and costs, when staffing for obstetrical anesthesia. Further study is needed to validate the use of ICD-9-CM codes for anesthesia complications as an indicator of quality.

Daniel C. Simonson, CRNA, MHPA, is Chief Anesthetist and Managing Partner, The Spokane Eye Surgery Center, Spokane, Washington.

Melissa M. Ahern, PhD, MBA, is Associate Professor, Department of Health Policy and Administration, Washington State University, Spokane.

Michael S. Hendryx, PhD, is Associate Professor, Department of Community Medicine; Research Director, Institute for Health Policy Research, West Virginia University School of Medicine, Morgantown.

Editor's Note Materials documenting the review process for this article are posted at

Accepted for publication September 17, 2006.

Corresponding author: Daniel Simonson, CRNA, MHPA, The Spokane Eye Surgery Center, 2607 S. Manito Blvd. Spokane, WA 99203 (e-mail:

© 2007 Lippincott Williams & Wilkins, Inc.