Postoperative outcomes associated with procedural sedation conducted by physician and non-physician anaesthesia providers: findings from the prospective, Observational African Surgical Outcomes Study (ASOS)

Background There is an unmet need for essential surgical services in Africa. Limited anesthesia services are a contributing factor. Non-physician anesthesia providers are utilized to assist with providing anesthesia and procedural sedation in order to make essential surgeries available. There is a paucity of data on outcomes following procedural sedation for surgery in Africa. We investigated the postoperative outcomes following procedural sedation by non-physicians and physicians in Africa. We hypothesized that the level of training of the sedation provider may be associated with the incidence of severe postoperative complications and death. Methods A secondary analysis of a prospective cohort of in-hospital adult surgical patients, representing 25 African countries was performed. An inverse probability of treatment weighting model was developed to assess the association between receiving procedural sedation conducted by a non-physician (vs physician) and in-hospital outcomes. All patients who only received procedural sedation for surgery were included. The primary outcome was the incidence of the composite of severe complications and death. Results 336 patients met the inclusion criteria, of which 98 (29.2%) received sedation from a non-physician provider. The incidence of severe postoperative complications and death was 10/98 (10.2%) in the non-physician group, and 5/238 (2.1%) in the physician group. The association between procedural sedation conducted by a nonphysician provider and in-hospital outcomes showed an eight-fold increase in the odds of severe complications and death (odds ratio 7.7; 95% CI 2.5 to 23.7). Conclusions The modest number of observations in this secondary data analysis, suggests that shifting the task of procedural sedation from physicians to non-physicians in order to increase access to care may be associated with severe postoperative complications and death in Africa. Research focusing on identifying factors contributing to adverse outcomes associated with procedural sedation is necessary to make this practice safer