"Opt Out" and Access to Anesthesia Care for Elective and Urgent Surgeries among U.S. Medicare Beneficiaries.

Abstract:

BACKGROUND:In 2001, the Centers for Medicare and Medicaid Services issued a rule allowing U.S. states to "opt out" of the regulations requiring physician supervision of nurse anesthetists in an effort to increase access to anesthesia care. Whether "opt out" has successfully achieved this goal remains unknown. METHODS:Using Medicare administrative claims data, we examined whether "opt out" reduced the distance traveled by patients, a common measure of access, for patients undergoing total knee arthroplasty, total hip arthroplasty, cataract surgery, colonoscopy/sigmoidoscopy, esophagogastroduodenoscopy, appendectomy, or hip fracture repair. In addition, we examined whether "opt out" was associated with an increase in the use of anesthesia care for cataract surgery, colonoscopy/sigmoidoscopy, or esophagogastroduodenoscopy. Our analysis used a difference-in-differences approach with a robust set of controls to minimize confounding. RESULTS:"Opt out" did not reduce the percentage of patients who traveled outside of their home zip code except in the case of total hip arthroplasty (2.2% point reduction; P = 0.007). For patients travelling outside of their zip code, "opt out" had no significant effect on the distance traveled among any of the procedures we examined, with point estimates ranging from a 7.9-km decrease for appendectomy (95% CI, -19 to 3.4; P = 0.173) to a 1.6-km increase (95% CI, -5.1 to 8.2; P = 0.641) for total hip arthroplasty. There was also no significant effect on the use of anesthesia for esophagogastroduodenoscopy, appendectomy, or cataract surgery. CONCLUSIONS:"Opt out" was associated with little or no increased access to anesthesia care for several common procedures.

journal_name

Anesthesiology

journal_title

Anesthesiology

authors

Sun EC,Dexter F,Miller TR,Baker LC

doi

10.1097/ALN.0000000000001504

subject

Has Abstract

pub_date

2017-03-01 00:00:00

pages

461-471

issue

3

eissn

0003-3022

issn

1528-1175

journal_volume

126

pub_type

杂志文章
  • Cyclosporine before Coronary Artery Bypass Grafting Does Not Prevent Postoperative Decreases in Renal Function: A Randomized Clinical Trial.

    abstract:BACKGROUND:Acute kidney injury is a common complication after cardiac surgery, leading to increased morbidity and mortality. One suggested cause for acute kidney injury is extracorporeal circulation-induced ischemia-reperfusion injury. In animal studies, cyclosporine has been shown to reduce ischemia-reperfusion injury...

    journal_title:Anesthesiology

    pub_type: 杂志文章,随机对照试验

    doi:10.1097/ALN.0000000000002104

    authors: Ederoth P,Dardashti A,Grins E,Brondén B,Metzsch C,Erdling A,Nozohoor S,Mokhtari A,Hansson MJ,Elmér E,Algotsson L,Jovinge S,Bjursten H

    更新日期:2018-04-01 00:00:00

  • Variations in pancuronium requirement, plasma concentration, and urinary excretion induced by cardiopulmonary bypass with hypothermia.

    abstract::To determine the effects of cardiopulmonary bypass (CPB) and hypothermia on the neuromuscular blockade produced by pancuronium, this relaxant was infused intravenously into 10 anesthetized patients to produce and maintain 90% depression of the twitch tension of the adductor pollicis muscle following supramaximal ulnar...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-198306000-00004

    authors: d'Hollander AA,Duvaldestin P,Henzel D,Nevelsteen M,Bomblet JP

    更新日期:1983-06-01 00:00:00

  • Effects of perioperative dexmedetomidine infusion in patients undergoing vascular surgery. The Study of Perioperative Ischemia Research Group.

    abstract:BACKGROUND:Dexmedetomidine, a highly selective alpha 2-adrenergic agonist, increases perioperative hemodynamic stability in healthy patients but decreases blood pressure and heart rate. The goal of this study was to evaluate, in a preliminary manner, the hemodynamic effects of perioperatively administered dexmedetomidi...

    journal_title:Anesthesiology

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1097/00000542-199503000-00003

    authors: Talke P,Li J,Jain U,Leung J,Drasner K,Hollenberg M,Mangano DT

    更新日期:1995-03-01 00:00:00

  • Spectral entropy as a measure of hypnosis and hypnotic drug effect of total intravenous anesthesia in children during slow induction and maintenance.

    abstract:BACKGROUND:We evaluated whether spectral entropy (SpE) can measure the depth of hypnosis and the hypnotic drug effect in children during total intravenous anesthesia. METHODS:Sixty healthy children, aged 3-16 yr, were studied. Anesthesia was induced with an increasing target controlled infusion of propofol, and mainta...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/ALN.0b013e3182410b5e

    authors: Klockars JG,Hiller A,Münte S,van Gils MJ,Taivainen T

    更新日期:2012-02-01 00:00:00

  • Respiratory Physiology for the Anesthesiologist.

    abstract::Respiratory function is fundamental in the practice of anesthesia. Knowledge of basic physiologic principles of respiration assists in the proper implementation of daily actions of induction and maintenance of general anesthesia, delivery of mechanical ventilation, discontinuation of mechanical and pharmacologic suppo...

    journal_title:Anesthesiology

    pub_type: 杂志文章,评审

    doi:10.1097/ALN.0000000000002666

    authors: Bigatello L,Pesenti A

    更新日期:2019-06-01 00:00:00

  • The threshold for thermoregulatory vasoconstriction during nitrous oxide/isoflurane anesthesia is lower in elderly than in young patients.

    abstract:BACKGROUND:Thermoregulatory vasoconstriction minimizes further core hypothermia during anesthesia. Elderly patients become more hypothermic during surgery than do younger patients, and take longer to rewarm postoperatively. These data indicate that perianesthetic thermoregulatory responses may be especially impaired in...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-199309000-00008

    authors: Kurz A,Plattner O,Sessler DI,Huemer G,Redl G,Lackner F

    更新日期:1993-09-01 00:00:00

  • Parental presence during induction of anesthesia: physiological effects on parents.

    abstract:BACKGROUND:The authors conducted a randomized controlled trial to determine whether parental presence during induction of anesthesia (PPIA) is associated with parental physiologic and behavioral manifestations of stress. METHODS:Children and their parents (N = 80) were randomly assigned to one of three groups: (1) PPI...

    journal_title:Anesthesiology

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1097/00000542-200301000-00013

    authors: Kain ZN,Caldwell-Andrews AA,Mayes LC,Wang SM,Krivutza DM,LoDolce ME

    更新日期:2003-01-01 00:00:00

  • Carcinogen bioassay of enflurane in mice.

    abstract::A carcinogen bioassay of enflurane was performed in Swiss/ICR mice. Two groups of weanling mice, each of 125 males and 125 females, were exposed to eigher a maximum tolerated dose of enflurane, 3000 ppm (0.3 per cent v/v) or compressed air for 4 hs per day, 5 days per week. After 52 weeks exposure, 25 males and 25 fem...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-198201000-00003

    authors: Baden JM,Egbert B,Mazze RI

    更新日期:1982-01-01 00:00:00

  • Awareness: Monitoring versus remembering what happened.

    abstract:BACKGROUND:Awareness during anesthesia is foremost assessed with postoperative interviews, which may underestimate its incidence. On-line monitors such as the Bispectral Index and patient response to verbal command are not necessarily commonly used. This study investigated response to command during deep sedation (Bisp...

    journal_title:Anesthesiology

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1097/00000542-200309000-00011

    authors: Kerssens C,Klein J,Bonke B

    更新日期:2003-09-01 00:00:00

  • Drug-induced amnesia is a separate phenomenon from sedation: electrophysiologic evidence.

    abstract:BACKGROUND:Sedative-hypnotic drugs not only increase sedation, but also impair memory as serum concentration increases. These drugs also produce profound changes in the auditory event-related potential (ERP). The ability of various ERP components to predict changes in sedation and memory produced by various drugs was t...

    journal_title:Anesthesiology

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1097/00000542-200110000-00018

    authors: Veselis RA,Reinsel RA,Feshchenko VA

    更新日期:2001-10-01 00:00:00

  • Malignant hyperthermia phenotype: hypotension induced by succinylcholine in susceptible swine.

    abstract:BACKGROUND:Succinylcholine causes immediate and severe arterial hypotension in swine with the malignant hyperthermia phenotype. The underlying mechanisms are unknown. METHODS:Malignant hyperthermia-susceptible (MHS; n = 10) and normal swine (n = 5) were anesthetized with thiopental. The following were monitored: elect...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-200006000-00038

    authors: Sigg DC,Iaizzo PA

    更新日期:2000-06-01 00:00:00

  • Incidence and root cause analysis of wrong-site pain management procedures: a multicenter study.

    abstract:BACKGROUND:Medical errors exact an inordinate toll on healthcare costs. One of the most publicized and analyzed type of medical error is wrong-site surgery. Yet, despite the burgeoning number of procedures performed, no literature exists on wrong-site pain management injections. The purpose of this study was to estimat...

    journal_title:Anesthesiology

    pub_type: 杂志文章,多中心研究

    doi:10.1097/ALN.0b013e3181cf892d

    authors: Cohen SP,Hayek SM,Datta S,Bajwa ZH,Larkin TM,Griffith S,Hobelmann G,Christo PJ,White R

    更新日期:2010-03-01 00:00:00

  • Comparison of 0.5% ropivacaine and 0.5% bupivacaine for epidural anesthesia in patients undergoing lower-extremity surgery.

    abstract::Ropivacaine is an amide local anesthetic structurally related to, but appearing less cardiotoxic, than bupivacaine. The authors' investigation was designed in a randomized, double-blind fashion to compare the clinical effectiveness of ropivacaine and bupivacaine in patients undergoing lower-extremity surgery. Forty-fi...

    journal_title:Anesthesiology

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1097/00000542-199004000-00010

    authors: Brown DL,Carpenter RL,Thompson GE

    更新日期:1990-04-01 00:00:00

  • Ventilatory response to CO2 following intravenous and epidural lidocaine.

    abstract::The authors determined the effects of intravenous infusion and epidural administration of lidocaine on the control of ventilation in two groups of eight healthy unpremedicated subjects. In the intravenous group, an injection of 1.5 mg/kg lidocaine was followed by an infusion at a rate of 60 micrograms X kg-1 X min-1 f...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-198508000-00011

    authors: Labaille T,Clergue F,Samii K,Ecoffey C,Berdeaux A

    更新日期:1985-08-01 00:00:00

  • Population pharmacokinetics and pharmacodynamics of thiopental: the effect of age revisited.

    abstract::The authors have previously attributed the mechanism for the 50-67% decrease in the required dose of thiopental for induction of anesthesia in aged human patients to a decrease in the initial distribution volume for thiopental. Using a larger group of patients and volunteers studied in the laboratory, the authors have...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-199003000-00003

    authors: Stanski DR,Maitre PO

    更新日期:1990-03-01 00:00:00

  • The minimum alveolar concentration of isoflurane in patients undergoing bilateral tubal ligation in the postpartum period.

    abstract:BACKGROUND:The minimum alveolar concentration (MAC) of volatile anesthetics is decreased during pregnancy, but MAC in the early postpartum period has not been reported. The aim of this study was to determine the MAC of isoflurane and to evaluate the relation between MAC and serum progesterone and beta-endorphin in pati...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-199506000-00007

    authors: Zhou HH,Norman P,DeLima LG,Mehta M,Bass D

    更新日期:1995-06-01 00:00:00

  • The influence of isoflurane on the vascular reflex response to lung inflation in dogs.

    abstract::Positive pressure ventilation can affect hemodynamic stability by neuroreflex-mediated activity. Inhalational anesthesia is known to attenuate the arterial baroreflex function; however, little information is known about the effect of volatile anesthetics on the lung inflation reflex. The influence of isoflurane on sta...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-199206000-00017

    authors: Cheng EY,Kay J,Hoka S,Bosnjak ZJ,Coon RL,Kampine JP

    更新日期:1992-06-01 00:00:00

  • Neuroprotective effect of epidural electrical stimulation against ischemic spinal cord injury in rats: electrical preconditioning.

    abstract:BACKGROUND:Electroconvulsion therapy is likely to serve as an effective preconditioning stimulus for inducing tolerance to ischemic brain injury. The current study examines whether electrical stimuli on the spinal cord is also capable of inducing tolerance to ischemic spinal cord injury by transient aortic occlusion. ...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-200507000-00015

    authors: Kakinohana M,Harada H,Mishima Y,Kano T,Sugahara K

    更新日期:2005-07-01 00:00:00

  • No evidence for blood flow redistribution with isoflurane or halothane during acute coronary artery occlusion in fentanyl-anesthetized dogs.

    abstract::The present study examines the postulate that isoflurane, in contrast to halothane, causes redistribution of blood flow away from an ischemic myocardial region through vasodilation of adjacent normally perfused myocardium. The study was performed in open-chest dogs anesthetized with fentanyl; ischemia was induced by o...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-199111000-00018

    authors: Moore PG,Kien ND,Reitan JA,White DA,Safwat AM

    更新日期:1991-11-01 00:00:00

  • Capsaicin combined with local anesthetics preferentially prolongs sensory/nociceptive block in rat sciatic nerve.

    abstract:BACKGROUND:Transient receptor potential vanilloid 1 channels integrate nociceptive stimuli and are predominantly expressed by unmyelinated C-fiber nociceptors, but not low-threshold mechanoreceptive sensory or motor fibers. A recent report showed that the transient receptor potential vanilloid 1 channel agonist capsaic...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/ALN.0b013e31818958f7

    authors: Gerner P,Binshtok AM,Wang CF,Hevelone ND,Bean BP,Woolf CJ,Wang GK

    更新日期:2008-11-01 00:00:00

  • Ventilatory effects of dexmedetomidine, atipamezole, and isoflurane in dogs.

    abstract::Dexmedetomidine (DMED) is a novel alpha 2 adrenergic agonist that has been shown to have potent analgesic and anesthetic sparing effects. This study was designed to investigate the effects of DMED, both alone and combined with isoflurane, on resting ventilation, the hypercapnic response, and the hypoxic response in do...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-199204000-00014

    authors: Nguyen D,Abdul-Rasool I,Ward D,Hsieh J,Kobayashi D,Hadlock S,Singer F,Bloor B

    更新日期:1992-04-01 00:00:00

  • Sodium channel in human malignant hyperthermia.

    abstract:BACKGROUND:The abundance of a specific sodium channel subunit (SkM2) appeared to be altered in vitro in cell cultures from persons susceptible to malignant hyperthermia. This study sought to determine whether these findings are artifacts of cell culture or whether they may be relevant to malignant hyperthermia. METHOD...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-199705000-00004

    authors: Fletcher JE,Wieland SJ,Karan SM,Beech J,Rosenberg H

    更新日期:1997-05-01 00:00:00

  • Comparison of the effects of etomidate, propofol, and thiopental on respiratory resistance after tracheal intubation.

    abstract:BACKGROUND:Tracheal intubation frequently results in reversible bronchoconstriction. Propofol has been reported to minimize this response in healthy patients and in asthma patients, but may be unsuitable for hemodynamically unstable patients for whom etomidate may be preferable. The current study examined respiratory r...

    journal_title:Anesthesiology

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1097/00000542-199606000-00005

    authors: Eames WO,Rooke GA,Wu RS,Bishop MJ

    更新日期:1996-06-01 00:00:00

  • Noninvasive Tracking of Anesthesia Neurotoxicity in the Developing Rodent Brain.

    abstract:BACKGROUND:Potential deleterious effect of multiple anesthesia exposures on the developing brain remains a clinical concern. We hypothesized that multiple neonatal anesthesia exposures are more detrimental to brain maturation than an equivalent single exposure, with more pronounced long-term behavioral consequences. We...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/ALN.0000000000002229

    authors: Makaryus R,Lee H,Robinson J,Enikolopov G,Benveniste H

    更新日期:2018-07-01 00:00:00

  • Neostigmine/glycopyrrolate administered after recovery from neuromuscular block increases upper airway collapsibility by decreasing genioglossus muscle activity in response to negative pharyngeal pressure.

    abstract:BACKGROUND:Reversal of residual neuromuscular blockade by acetylcholinesterase inhibitors (e.g., neostigmine) improves respiratory function. However, neostigmine may also impair muscle strength. We hypothesized that neostigmine administered after recovery of the train-of-four (TOF) ratio impairs upper airway integrity ...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/ALN.0b013e3181f70f3d

    authors: Herbstreit F,Zigrahn D,Ochterbeck C,Peters J,Eikermann M

    更新日期:2010-12-01 00:00:00

  • Effect of alpha2B-adrenoceptor polymorphism on peripheral vasoconstriction in healthy volunteers.

    abstract:BACKGROUND:Alpha-2B adrenoceptor is the vasoconstrictive subtype in the mouse. Human alpha2B-AR deletion (D) allele has been associated with loss of short-term agonist-promoted receptor desensitization, which may lead to increased vasoconstriction on alpha2 activation. The goal of this study was to test the hypothesis ...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-200503000-00010

    authors: Talke P,Stapelfeldt C,Lobo E,Brown R,Scheinin M,Snapir A

    更新日期:2005-03-01 00:00:00

  • Early but no long-term benefit of regional compared with general anesthesia for ambulatory hand surgery.

    abstract:BACKGROUND:The purpose of this study was to determine whether either regional anesthesia (RA) or general anesthesia (GA) provided the best analgesia with the fewest adverse effects up to 2 weeks after ambulatory hand surgery. METHODS:Patients undergoing ambulatory hand surgery were randomly assigned to RA (axillary br...

    journal_title:Anesthesiology

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1097/00000542-200408000-00028

    authors: McCartney CJ,Brull R,Chan VW,Katz J,Abbas S,Graham B,Nova H,Rawson R,Anastakis DJ,von Schroeder H

    更新日期:2004-08-01 00:00:00

  • Adaptive support ventilation: an appropriate mechanical ventilation strategy for acute respiratory distress syndrome?

    abstract:BACKGROUND:Adaptive support ventilation (ASV) allows the clinician to set a maximum plateau pressure (PP) and automatically adjusts tidal volume to keep PP below the set maximum. METHODS:ASV was compared to a fixed tidal volume of 6 ml/kg. ASV determined the respiratory rate and tidal volume based on its algorithms. M...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/ALN.0b013e3181b55f8f

    authors: Sulemanji D,Marchese A,Garbarini P,Wysocki M,Kacmarek RM

    更新日期:2009-10-01 00:00:00

  • Morphine inhibits spontaneous and cytokine-enhanced natural killer cell cytotoxicity in volunteers.

    abstract:BACKGROUND:Opioids are used by patients who have conditions ranging from the acute pain of surgery and chronic cancer pain to substance abuse. Despite their widespread use and considerable experimental data about them, little is known about how opioids may alter in vivo immunity in humans. This study was designed to ev...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-199509000-00008

    authors: Yeager MP,Colacchio TA,Yu CT,Hildebrandt L,Howell AL,Weiss J,Guyre PM

    更新日期:1995-09-01 00:00:00

  • Effect of edrophonium and neostigmine on the pharmacokinetics and neuromuscular effects of mivacurium.

    abstract:BACKGROUND:Previous studies demonstrated that both edrophonium and neostigmine affect mivacurium's pharmacokinetics, thereby potentially affecting its recovery profile. However, those studies were not clinically relevant because mivacurium was still infused after the antagonists were given. In the present study, the au...

    journal_title:Anesthesiology

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1097/00000542-200003000-00015

    authors: Szenohradszky J,Fogarty D,Kirkegaard-Nielsen H,Brown R,Sharma ML,Fisher DM

    更新日期:2000-03-01 00:00:00