Cause-specific mortality risks of anesthesiologists

BACKGROUND: The health-related effects of the operating room environment are unclear. The authors compared mortality risks of anesthesiologists to those of internal medicine physicians between 1979 and 1995. METHODS: The Physician Master File database, a listing of all US physicians, was used to identify anesthesiologists and general internists. The cohort of internists (n = 40,211) was a stratified random sample of all internists, frequency-matched to the cohort of anesthesiologists (n = 40,242) by gender, decade of birth, and US citizenship. The National Death Index was used to confirm death status and to determine specific causes of death. Mortality risks, adjusted for age, gender, and race, were compared using the Cox proportional hazards regression model. RESULTS: The standardized mortality ratios for all physicians were well below 1.0, except for suicide. The all-cause mortality ratios, and the risks of death caused by cancer and heart disease, did not differ between anesthesiologists and internists. Anesthesiologists had an increased risk of death from suicide (rate ratio [RR] = 1.45, 95% confidence interval [CI] = 1.07 - 1.97), drug-related death (RR = 2.79, 95% CI = 1.87 - 4.15), death from other external causes (RR = 1.53, 95% CI = 1.05 - 2.22), and death from cerebrovascular disease (RR = 1.39, 95% CI = 1.08 - 1.79). Male anesthesiologists had an increased risk of death from HIV (RR = 1.82, 95% CI = 1.09 - 3.02) and viral hepatitis (RR = 7.98, 95% CI = 1.0 - 63.84). Although the risk to anesthesiologists of drug-related deaths was highest in the first 5 years after medical school graduation, it remained increased over that of internists throughout the career. CONCLUSIONS: Substance abuse and suicide represent significant occupational hazards for anesthesiologists. New methods to combat substance abuse among anesthesiologists should be developed.     

Anesthesiologists in France

We review some anesthesiologist's curriculum and demographic characteristics in France to the community of Japanese anesthesiologists. To become a certified anesthesiologist and an intensive care physician currently requires six years' medical education, passing national medical examination, and five years' special training as an intern of anesthesiology and intensive care. This educational course was started in 1984. There are 7942 certified anesthesiologists in France in 1999. The average age is 45.9 years and the ratio of female is 35.3%. Approximately two thirds of certified anesthesiologists are working in public institutions. 89% is full-time workers. More than half of certified anesthesiologists actually participate in daily intensive care practice. The number of certified anesthesiologists has been increasing gradually totaling 10,062 persons in 2005. The number of certified anesthesiologists per ten thousands general population is 1.7 persons and the corresponding ratio to all medical doctors is 4.8%. Working hours and holidays are regulated by the French Labour Law. The anaesthesiologist often works in a team with a nurse anaesthetist. The number of certified anesthesiologists in France is larger than that in Japan. Management of anesthesia in France seems to have an advantage in manpower.     

Inhibitors of mTOR and Risks of Allograft Failure and Mortality in Kidney Transplantation

Data on long‐term outcomes of users of inhibitors of the mammalian target of rapamycin (mTORI) are lacking in kidney transplantation. In an analysis of 139 370 US kidney transplant recipients between 1999 through 2010, we compared clinical outcomes among users of mTORIs versus calcineurin inhibitors (CNI) in their primary immunosuppresive regimen. During the first 2 years posttransplantation, primary use of mTORIs without CNIs (N = 3237) was associated with greater risks of allograft failure and death compared with a CNI‐based regimen (N = 125 623); the hazard ratio (HR) of the composite outcome ranged from 3.67 (95% confidence interval [CI], 3.12–4.32) after discharge to 1.40 (95% CI 1.26–1.57) by year 2. During years 2–8, primary use of mTORIs without CNIs was independently associated with greater risks of death (HR 1.25; 95% CI, 1.11–1.41) and the composite (HR 1.17; 95%CI, 1.08–1.27) in fully adjusted analyses. The results were qualitatively unchanged in subgroups defined by medical history, immunological risk and clinical course during the index transplant hospitalization. In a propensity‐score matched cohort, use of mTORIs was associated with significantly worse outcomes during the first 2 years and greater risks of death (HR 1.21; 95% CI, 1.05–1.39) and the composite (HR 1.18; 95% CI, 1.08–1.30) in years 2–8. Compared with CNI‐based regimens, use of an mTORI‐based regimen for primary immunosuppression in kidney transplantation was associated with inferior recipient survival.