Into the Wilderness?: The Growing Importance of Nonoperating Room Anesthesia Care in the United States

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As the health care environment is becoming more competitive for cost reductions and achieving value-based targets through benchmarking, physician anesthesiologists are increasingly being asked to demonstrate their importance in this equation to hospitals and larger health care systems. For instance, comparisons are sometimes made with other nonphysician anesthesia providers (eg, nurse anesthetists) or nonanesthesiologists. In a recent article, Nagrebetsky et al1 highlight a growing area for physician anesthesiologists to demonstrate their value: the provision of anesthesia care outside the operating room (OR). Although anesthesia care is typically provided in an OR setting, anesthesiologists are often asked to provide anesthesia outside the OR, such as in the magnetic resonance imaging (MRI) suite, catheterization laboratory, or in endoscopy suites. Using data from the National Anesthesia Clinical Outcomes Registry (NACOR), a large database of anesthesia cases, Nagrebetsky et al1 found that non–OR anesthesia care (NORA) increased from 28.3% to 35.9% of all anesthetics between 2010 and 2014, in both hospital-based and nonhospital-based settings. The authors also found that patients presenting for NORA were older and had a higher American Society of Anesthesiologists physical status score compared with patients receiving care in the OR.
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