Comparison of Anesthesia for Dental/Oral Surgery by Office-based Dentist Anesthesiologists versus Operating Room-based Physician Anesthesiologists
Few studies have examined the practice characteristics of dentist anesthesiologists and compared them to other anesthesia providers. Using outcomes from the National Anesthesia Clinical Outcomes Registry and the Society for Ambulatory Anesthesia Clinical Outcomes Registry for dental/oral surgery procedures, we compared 7133 predominantly office-based anesthetics by dentist anesthesiologists to 106,420 predominantly operating room anesthetics performed by physician anesthesia providers. These encounters were contrasted with 34,191 previously published encounters from the practices of oral and maxillofacial surgeons. Children younger than 6 years received the greatest proportion of general anesthetic services rendered by both dentist anesthesiologists and hospital-based anesthesia providers. These general anesthesia services were primarily provided for complete dental rehabilitation for early childhood caries. Overall treatment time for complete dental rehabilitation in the office-based setting by dentist anesthesiologists was significantly shorter than comparable care provided in the hospital operating room and surgery centers. The anesthesia care provided by dentist anesthesiologists was found to be separate and distinct from anesthesia care provided by oral and maxillofacial surgeons, which was primarily administered to adults for very brief surgical procedures. Cases performed by dentist anesthesiologists and hospital-based anesthesia providers were for much younger patients and of significantly longer duration when compared with anesthesia administered by oral and maxillofacial surgeons. Despite the limited descriptive power of the current registries, office-based anesthesia rendered by dentist anesthesiologists is clearly a unique and efficient mode of anesthesia care for dentistry.
Most patients receiving general anesthesia from either OR anesthesia providers (a) or dentist anesthesiologists (b) are children between 2 and 6 years of age. This age range also corresponds to the ages in which early childhood caries is found.
(a) A comparison of surgical case duration in National Anesthesia Clinical Outcomes Registry–DENTAL and Society for Ambulatory Anesthesia Clinical Outcomes Registry (SAMBA-SCOR) registries. Surgical duration is defined as the difference between surgical start and stop times, in minutes. (b) A comparison of ambulatory surgery center and office-based venues with regard to induction time, perioperative time, and recovery time. All cases were performed by the dentist anesthesiologists in the SAMBA-SCOR registry.
Age distributions for the National Anesthesia Clinical Outcomes Registry–DENTAL and Society for Ambulatory Anesthesia Clinical Outcomes Registry data sets (also shown in Figures 1a and 1b) and superimposes them on a graph where the y-axes are equalized. The near superimposition of the plots suggests a common source of patients for both registries. This source is most likely the population of children with early childhood caries.
This graph compares the mean age of patients undergoing general anesthesia in this study to the mean age of patients undergoing general anesthesia in oral surgery offices, as reported by Perrott et al.4 Although no significant difference in age is noted between the patients in the National Anesthesia Clinical Outcomes Registry (NACOR)–DENTAL and Society for Ambulatory Anesthesia Clinical Outcomes Registry (SAMBA-SCOR) data sets in this study, the difference in mean age for oral surgery patients is highly significant for both NACOR-DENTAL and SAMBA-SCOR.
A comparison of total anesthesia time in the data sets of this study to total anesthesia time for patients undergoing general anesthesia in oral surgery offices, as reported by Perrott et al.4 Nearly all cases of general anesthesia performed by oral surgeons are less than 30 minutes in length, whereas cases of 1–2 hours' duration or longer comprise a significant proportion of cases seen by the providers in the National Anesthesia Clinical Outcomes Registry–DENTAL and Society for Ambulatory Anesthesia Clinical Outcomes Registry data sets.
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