Austin, Thomas M.

AbstractThe coronavirus disease 2019 (COVID‐19) pandemic created unprecedented challenges for anesthesiologists both at work and home. This study examined whether the pandemic affected academic productivity and career satisfaction among anesthesiologists practicing in the United States during the early stages of the pandemic and whether these effects differed by gender. A survey was emailed to 25,473 members of the American Society of Anesthesiologists to learn about their experiences during the beginning of the pandemic. The survey directed respondents to rate their change in academic productivity, clinical care hours, scholarly and leadership opportunities, income, childcare duties, and household responsibilities during the first 5 months of the pandemic (March 1–July 31, 2020). The primary variable was gender, academic productivity was the primary outcome, and data were analyzed by multivariable proportional odds logistic regression models and correlations. Female anesthesiologists reported lower academic productivity and career satisfaction relative to male anesthesiologists during the study period. Career satisfaction positively correlated with academic productivity. Compared to male anesthesiologists, female anesthesiologists also had more household responsibilities before and during the pandemic. Being a female parent reduced academic productivity relative to that reported by nonparents of either gender. In conclusion, the early months of the COVID‐19 pandemic had a greater adverse professional impact on female anesthesiologists than on their male counterparts. Efforts to support and retain female anesthesiologists, particularly those early in their careers and those with children, are essential for the specialty to maintain its workforce and promote gender equity in promotion and leadership.

SummaryBackgroundChildren undergoing posterior spinal fusion experience high blood loss often necessitating transfusion. An appropriately activated coagulation system provides hemostasis during surgery, but pathologic dysregulation can cause progressive bleeding and increased transfusions. Despite receiving antifibrinolytics for clot stabilization, many patients still require transfusions.AimsWe sought to examine the association of dilutional coagulopathy with blood loss and blood transfusion in posterior spinal fusion for pediatric scoliosis patients.MethodsA retrospective, single institution study of children undergoing posterior spinal fusion >6 levels with a standardized, prospective anesthetic protocol utilizing antifibrinolytics. Blood loss was evaluated using a hematocrit‐based calculation. To evaluate transfusions, a normalized Blood Product Transfusion calculation was developed. Factors associated with blood loss and blood transfusions were determined by univariate analysis and multivariate regression modeling with multicollinearity and mediation analysis.ResultsPatients received 73.7 mL/kg (standard deviation ±30.8) of fluid poor in coagulation factors. Estimated blood loss was 42.6 mL/kg (standard deviation ±18.0). There was a significant association between estimated blood loss and total fluids delivered (Spearman's rho = 0.51, 95% confidence interval 0.33‐0.65, P < 0.001). Factors significantly associated with normalized Blood Product Transfusion in this cohort included age, weight, scoliosis type, levels fused, total osteotomies, pelvic fixation, total fluid, maximum prothrombin time, and minimum fibrinogen. Regression modeling showed the best combination of variables for modeling normalized Blood Product Transfusion included patient weight, number of levels fused, total fluid administered, and maximum prothrombin time.ConclusionBlood product transfusion remains a frustrating problem in pediatric scoliosis. Identifying and controlling dilutional coagulopathy in these patients may reduce blood loss and the need for blood transfusion.