Glance and colleagues (The Impact of Anesthesiologists on Coronary Artery Bypass Graft Surgery Outcomes) demonstrate that patients managed by the highest (best) quartile of anesthesiologists have half the risk of serious complications following cardiac surgery as patients managed by the lowest (worst) quartile of anesthesiologists. Five accompanying editorials reinforce the observation that anesthesiologists make a difference. (1- Anesthesiologists Make a Difference, 2- Does It Matter Who the Anesthesiologist Is for My Heart Surgery?, 3- Facing the Uncomfortable Truth: Your Choice of Anesthesiologist Does Matter, 4- Cardiac Surgery: All for One and One for All, 5- Making a Difference: The Anesthesia Quality Institute).
Lee and colleagues (Long-Term Quit Rates After a Perioperative Smoking Cessation Randomized Controlled Trial) found that a simple perioperative intervention of counseling, brochures, access to a telephone “quit-line,” and free nicotine replacement therapy helped smokers remain tobacco-free for a year after surgery. Warner notes in his editorial (Helping Surgical Patients Quit Smoking: Time to Bring It Home) that smoking cessation interventions should be a routine part of perioperative care.
As documented by Hand and colleagues (Hydroxyethyl Starch and Acute Kidney Injury in Orthotopic Liver Transplantation: A Single-Center Retrospective Review), the Medical University of South Carolina switched from 5% albumin to 6% hydroxyethyl starch for orthotopic liver transplantation, but reverted to albumin following a statistically significant increase in acute kidney injury. In patients undergoing radical prostatectomy, Kancir and colleagues (The Effect of 6% Hydroxyethyl Starch 130/0.4 on Renal Function, Arterial Blood Pressure, and Vasoactive Hormones During Radical Prostatectomy: A Randomized Controlled Trial) did not find evidence of renal injury from hydroxyethyl starch, but did find an association with higher blood loss.
Naveen Nathan, MD, Cover Editor and Illustrator:
It is an infrequent occurrence in which a patient selects their anesthesiologist and even less so when they understand the quality of their care. Articles contained herein expose the influence one’s anesthesia care provider has on clinical outcomes in cardiothoracic surgery. Amongst all possibilities, the patient on this month’s cover has picked a high-ranking face card, a king of hearts, whose crown bears the aromatic rings that signify an understanding of pharmacologic principles. The right hand inscribes on parchment, alluding to the immense body of medical knowledge that has developed from forward-thinking anesthesiologists. The figure also braces a transesophageal echocardiography probe as a reflection of unique skill sets. The image demonstrates the random nature by which patients are assigned to their anesthesiologist, essentially no more than luck of the draw.