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Background and Objective: The aim of this arm of the ANESCAT 2003 study was to describe the use of emergency anesthesia in surgical specialties in Catalonia, Spain., Patients and Method: The data analyzed came from a prospective study of the anesthetic procedures performed in 131 hospitals in Catalonia on 14 randomly chosen days in 2003. Emergency anesthetic procedures for surgery (excluding obstetrics and nonsurgical procedures) were selected and the following variables analyzed: type of hospital, patient characteristics, procedure, anesthetic technique, time used, postoperative care, and type of emergency (deferrable or not). Data are expressed as medians (10th-90th percentile) and extrapolated to the population of Catalonia., Results: Out of 23,136 anesthetic procedures recorded, 2,088 (corresponding to an estimated 54,437 anesthetic procedures in Catalonia annually) were associated with surgical emergencies; that figure represents 9% of all anesthetic procedures and 11.5% of anesthetic procedures performed for surgery. The emergency was deferrable in 51% of cases (an estimated 26,906 anesthetic procedures annually). A total of 81.2% of the emergency procedures were performed in hospitals belonging to the public system and 18.8% in private hospitals. Procedures performed from Monday to Friday accounted for 80.6% of emergency procedures. Procedures performed between the hours of 08:00 and 16:00 accounted for 46.5% of the total and 8.1% were performed between 00:00 and 08:00. Sixty percent of deferrable procedures were undertaken between 08:00 and 16:00. Men accounted for 52.4% of all patients, the median age was 51 (15-83) years, and 15.3% of patients were severely ill (American Society of Anesthesiologists physical status class 4). Taken together, orthopedic surgery and traumatology, and general and digestive surgery accounted for 74.4% of the anesthesia practice considered. General anesthesia was used in 51% of cases and regional anesthesia in 38%. The length of anesthesia was greater in deferrable emergencies (90 minutes). Patients were admitted to postoperative critical care units in 18% of cases., Conclusions: Anesthesia for surgical emergencies accounted for around 10% of the anesthetic procedures performed in Catalonia in 2003, and more than 50% of those procedures could have been deferred.

Background and Objective: The aim of this arm of the ANESCAT 2003 study was to describe obstetric anesthesia and analgesia practice in Catalonia, Spain., Patients and Method: Using information obtained from a survey of anesthesia performed in Catalonia in 2003, data was identified on anesthesia for obstetric procedures: labor, cesarean section, and others unrelated to childbirth. Patient characteristics were analyzed along with anesthetic techniques and the rates at which they are used in the population., Results: Obstetric procedures were performed in 71 hospitals (54% of the hospitals surveyed). Obstetric anesthesia represented 11.3% of total anesthesia practice, corresponding to an estimated 67,864 anesthetic procedures per year. Of those procedures, 87.7% were associated with labor and childbirth. An estimated 82% of the 71,851 births in Catalonia were assisted by an anesthesiologist. Cesarean sections accounted for 25.1% of births and the rate increased with age. Regional anesthesia for labor and cesarean section was used in 98.7% and 96.2% of cases, respectively. Epidural anesthesia was used in 96.9% of vaginal births. In elective and emergency cesarean sections, spinal block was used in 75.5% and 44.8% of cases, respectively, while epidural anesthesia was used in 23.3% and 53.3%, respectively., Conclusions: The anesthesia coverage for labor in Catalonia is the highest published. The use of regional anesthetic techniques in Catalonia is also the highest recorded. Although continuous epidural anesthesia is the most widely used technique, spinal block is also increasingly employed.

Background and Objective: The aim of this arm of the ANESCAT 2003 study was to describe the temporal distribution and types of anesthesia used in Catalonia, Spain, in 2003, along with the associated human resources used., Patients and Method: Data were used from a survey of 23,136 anesthetic procedures collected on 14 randomly selected days in 2003 and an individual questionnaire was completed by 765 anesthesiologists working in Catalonia., Results: Anesthesia practice was divided into that associated with surgery (78.4%), obstetrics (11.3%), and other nonsurgical procedures (10.4%). Of all anesthetic procedures performed, 84.3% took place in operating theaters and 7.0% in obstetric areas. Emergency procedures accounted for 20.3% of the total. Most procedures (71.2%) were undertaken within 08:00 and 16:00 h, and the lowest number of procedures performed on workdays took place on Fridays. The median duration of anesthesia was 60 minutes. The most common technique was regional anesthesia (41.4%), with spinal block being the most widely used. There were an estimated 12.5 anesthesiologists per 100,000 inhabitants, with a median (10th-90th percentile) age of 45 (34-57) years; women made up 47.2% of that group. The mean number of standard working hours was 46 hours per week and 65% of anesthesiologists also undertook on duty shifts. Anesthesiologists spent 77% of their time performing anesthesia and the remainder in postoperative recovery and critical care units and pain clinics., Conclusions: Emergency anesthesia represents 20% of the total workload and obstetrics and nonsurgical procedures another 20%. The use of regional anesthesia was very widespread. The population density of anesthesiologists is comparable to that of other European countries, but with a higher proportion of women.

Background and Objective: The objective of this arm of the ANESCAT 2003 study was to analyze the characteristics of the youngest and oldest patients receiving anesthesia in Catalonia, Spain, and the procedures for which they require it., Patients and Method: We analyzed data from questionnaires pertaining to pediatric (under age 14 years) and geriatric patients (older than age 65 years)., Results: Pediatric patients underwent 6.3% of all anesthetic procedures and patients over 65 years old accounted for 32.9% of the sample population. Two of every 3 pediatric patients were males, whereas 55% of patients over age 65 years were females. The most frequently performed interventions requiring anesthesia in patients under 14 years of age were tonsillectomy and/or adenoidectomy (19.3%), nonsurgical procedures (11.5%), circumcision (10.6%), inguinal herniorrhaphy (8.3%), and appendectomy (4.2%). The most common procedures in elderly patients were cataract extraction (31.9%), nonsurgical procedures (9.5%), inguinal herniorrhaphy (4.4%), total knee replacement (3.6%), transurethral bladder surgery (3.2%), and repair of femoral neck fractures (2.6%). Because of the high incidence of appendectomy in patients between 8 and 14 years old and of femoral neck fractures in patients over 85 years old, the rate of emergency anesthesias in patients in those age brackets was around 30%., Conclusions: Pediatric and geriatric patients and the interventions for which they are administered anesthesia have particular features. Taking them into consideration in the short term would facilitate the development of new therapeutic strategies and the introduction of changes in health care organization.

Background and Objective: Perioperative care and chronic pain therapy are anesthesia practices that aim to improve patient safety and well-being. The purpose of this arm of the ANESCAT survey of anesthesia practices in Catalonia, Spain, in 2003 was to describe and quantify these 2 services., Patients and Method: Taking relevant responses to the ANESCAT 2003 questionnaires, we analyzed type of preanesthetic assessment, use of specialized techniques for postoperative analgesia, and provision of postoperative critical care. We also estimated type and volume of procedures performed by anesthesiologists to treat chronic pain., Results: A preanesthetic assessment visit took place in an outpatient clinic setting in 47.4% of cases, on a hospital ward in 18.3%, and in the operating room waiting area in 34.3%. Specialized analgesic techniques were provided for 7.6% of postoperative patients, a rate that would put the estimated number of such procedures at 30,321 per year. Postoperative critical care was afforded to 7.7% of patients in the sample, a rate that extrapolates to anesthesia in 44,686 patients in Catalonia annually. Patients benefiting from specialized analgesic techniques and postoperative critical care were older, had worse physical status classifications, and were anesthetized for more aggressive procedures. Approximately 120,000 medical acts related to treatment for chronic pain were undertaken by anesthetists in Catalonia in 2003., Conclusions: The findings of ANESCAT 2003 reveal the considerable scope of Catalan anesthetists' practice in perioperative care management and chronic pain therapy, but more human resources and organizational attention are still needed for ideal workload management.

Background and Objective: The aim of this arm of the ANESCAT study was to characterize anesthesia practice in the various types of health care facilities of Catalonia, Spain, in 2003., Patients and Method: We analyzed data from the survey according to a) source of a facility's funding: public hospitals financed by the Catalan Public Health Authority (ICS), the network of subsidized hospitals for public use (XHUP), or private hospitals; b) size: facilities without hospital beds, hospitals with fewer than 250 beds, those with 251 to 500, and those with over 500; and c) training accreditation status: whether or not a facility gave medical resident training., Results: A total of 131 facilities participated (11 under the ICS, 47 from the XHUP, and 73 private hospitals). Twenty-six clinics had no hospital beds, 78 facilities had fewer than 250, 21 had 251 to 500, and 6 had more than 500. Seventeen hospitals trained medical residents. XHUP hospitals performed 44.3% of all anesthetic procedures, private hospitals 36.7%, and ICS facilities 18.5%. Five percent of procedures were performed in clinics without beds, 42.9% in facilities with fewer than 250 beds, 35% in hospitals with 251 to 500, and 17.1% in hospitals with over 500. Anesthetists in teaching hospitals performed 35.5% of all procedures. The mean age of patients was lower in private hospitals, facilities with fewer than 250 beds, and hospitals that did not train medical residents. The physical status of patients was worse in ICS hospitals, in facilities with over 500 beds, and in teaching hospitals. It was noteworthy that 25% of anesthetic procedures were performed on an emergency basis in XHUP and ICS hospitals, in facilities with more than 250 beds, and in teaching hospitals. Anesthesia for outpatient procedures accounted for 40% of the total in private hospitals and 31% of the practice in ICS and XHUP hospitals. The duration of anesthesia and postanesthetic recovery was longer in ICS hospitals, in facilities with over 500 beds, and in those with medical resident training programs. The numbers of postoperative admissions to critical care units and of specialized analgesic techniques performed were higher in ICS hospitals, in facilities with over 500 beds, and in teaching hospitals., Conclusions: The complexity of both anesthesia and surgical practice and the severity of patient condition increased with hospital size and public funding status.

The ANESCAT 2003 survey has provided reliable information on all practices within the specialty of anesthesiology in a community comprising 6.7 million inhabitants (namely Catalonia, Spain). In a situation in which official statistics are lacking, the findings allow us to make predictions and plan the clinical and organizational needs of the specialty. We discovered that 9 of every 100 residents of Catalonia received anesthesia in 2003 and that the proportion of elderly and high risk patients among them is high. The rates of obstetric and nonsurgical anesthesia were also high. New information on the characteristics of surgical uses of anesthesia that has emerged can now be used for health care planning. Based on population trends--both overall increase and gradual aging--we can foresee increases in demand for anesthesia of around 12% and 20% in the years 2008 and 2013, respectively, although demand may also rise unpredictably if new health care policy measures are introduced suddenly. A growing demand for anesthesia in nonsurgical interventions, perioperative medicine, critical care, and pain therapy was also documented. The workload of anesthesiologists in developing areas exceeds the volume in surgical anesthesia by 30%. Practice in such areas of anesthesiology is comprised of a large range of techniques that differ substantially in complexity and that require reorganization of human resources, equipment and medical resident training programs. The population density observed was 12.7 anesthesiologists per 100,000 inhabitants, reflecting a current deficit that will probably persist over the next 5 years and lead to a serious human resources availability crisis within 10 years, given the age pyramid and the number of residents in training at present. The ANESCAT 2003 survey demonstrates the ability of a scientific society and its members to analyze health care practices in their field and to foresee the effects of expected trends.

Background and Objective: This arm of the ANESCAT survey sought to characterize and quantify nonsurgical anesthesia practice in Catalonia, Spain., Patients and Method: Information about anesthesia for nonsurgical procedures in 131 Catalan hospitals was gathered prospectively on 14 days in 2003. We analyzed patient characteristics, anesthetic techniques, procedures, duration, interventional context for the anesthetic procedure, type of hospital, and geographic distribution., Results: Nonsurgical anesthesia accounted for 10.4% of all acts. Endoscopy of the digestive tract accounted for 70.4% of all nonsurgical procedures, electroconvulsive treatment for 11.7%, radiology for 11.5%, and electrical cardioversion for 1.5%. Anesthesia was provided outside an operating room in 73.7% of the cases. Most procedures were scheduled to be performed in outpatients under sedation or general anesthesia. The most commonly performed digestive tract endoscopic examinations were colonoscopy and gastroscopy, and most took place in private hospitals., Conclusions: Over 10% of anesthesia practice is for nonsurgical procedures and digestive tract endoscopy accounts for the largest proportion of such practice. As the trend is for such procedures to increase in number, their frequency should be studied so that organization and training can be planned.

Background and Objective: The increasing workload in anesthesiology together with the shortage of anesthetists has led to worldwide concern within the specialty. In 2003, the Catalan Society of Anesthesiology, Critical Care and Pain Therapy undertook the ANESCAT survey to determine the anesthesia practice workload in Catalonia, Spain., Patients and Method: A set of 3 questionnaires was used to quantify anesthesia practice and resources. A sample size of 12,228 events was estimated to be necessary to be representative of the number of anesthetic procedures carried out in Catalonia annually. A prospective, cross-sectional survey was carried out on 14 randomly chosen days in 2003. Each hospital designated a coordinator responsible for ensuring that a questionnaire was filled in for each anesthetic procedure, to provide information about patient characteristics, anesthetic technique, and the intervention for which anesthesia was needed., Results: All 131 public and private hospitals in which anesthetic procedures were carried out participated. The geographic distribution was as follows: Barcelona city, 54 (41.2%); rest of the province of Barcelona, 39 (29.8%); Tarragona, 15 (11.5%); Girona, 14 (10.7%), and Lleida, 9 (6.9%). A total of 23,136 questionnaires about anesthesia procedures were received; the number of questionnaires returned on the selected workdays varied by 1.85% and the percentage of incomplete returns was less than 5%. The number of individual anesthetists returning questionnaires for processing was 765., Conclusions: This large-scale study was possible thanks to a simple design and the strong motivation of a community of anesthesiologists. The results have provided an accurate picture of anesthesia practice within a specific geographical area. Such studies are necessary for introducing organizational changes and applying for additional resources.

Background and Objective: This article provides an epidemiological description of anesthesia practice in Catalonia, Spain, in 2003., Patients and Method: Descriptive data on sex, age, and physical status of patients according to American Society of Anesthesiologists (ASA) classification were taken from responses to the questionnaire used in the ANESCAT 2003 survey. The results were extrapolated to the population of Catalonia in 2003 and the annual rates of anesthesia per 100 inhabitants calculated., Results: Based on the 23,136 completed questionnaires collected in the ANESCAT 2003 survey, it is estimated that 603,189 anesthetic procedures were performed in Catalonia (95% confidence interval [CI], 579,010-627,368). The annual rate of anesthesia was 9 per 100 inhabitants (95% CI, 8.6-9.4). Women represented 58% of the population in which anesthesia was performed. The median (10th-90th percentile) age was 52 (21-78) years and anesthetic procedures performed in patients over the age of 60 accounted for 39.3% of the total. The largest number of anesthetic procedures was performed in the 70 to 74 year age bracket (56,000 procedures). Below the age of 14, more males than females received anesthesia, while above that age the majority of patients were female. The highest rate of anesthesia was in men aged between 75 and 79 years (22.0%) and the lowest was in girls aged between 10 and 14 years (1.8%). The percentage of patients with an ASA class of 3 or more was 26.7%. Physical status was worse in male than in female patients. Forty-seven percent of all anesthetic procedures were performed in the city of Barcelona., Conclusions: The annual rate of anesthesia in Catalonia was 9 per 100 inhabitants, and was almost 3 times higher in the city of Barcelona than in the rest of the geographical area. Comparison with data from other European countries revealed higher severity and a larger proportion of women and older patients in Catalonia.

Background and Objective: The aim of this arm of the ANESCAT study was to describe the characteristics of ambulatory anesthesia in Catalonia, Spain., Patients and Method: Relevant data was extracted from a survey of anesthetic procedures in 131 public, publicly contracted, and private hospitals on 14 representative days in 2003., Results: Of the estimated 603,189 anesthesias performed, 206,992 (34.32%; 95% confidence interval, 33.3%-35.4%) were on outpatients. The median (10th to 90th percentile) age of patients was 59 (22-80) years and 56.6% were women. The physical status of patients according to the American Society of Anesthesiologists (ASA) classification was ASA I or II for 75.1% of the patient sample. The most common approach to anesthesia was sedation/monitoring (47.7%), followed by regional anesthesia (28.9%). The types of regional anesthesia reported most often were peri- or retrobulbar blocks (50.8% of the regional blocks), followed by spinal anesthesia (22.2%). Anesthesia was required for surgery in 76.5% of the cases and for diagnostic or other nonsurgical procedures in 22%. The individual surgical specialties creating the greatest demand for anesthetic procedures were ophthalmology (39%) and orthopedic and trauma surgery (10.9%). The specific interventions accounting for the largest percentages of anesthetic procedures were cataract extraction (32.3%) and digestive tract endoscopy (16.7%). In 8.2% of the cases, patients did not require a stay in the postanesthetic recovery unit. Private hospitals, facilities with fewer than 250 beds, and those not accredited to provide medical resident training had higher rates of ambulatory anesthesia., Conclusions: Ambulatory procedures account for approximately a third of the anesthesia workload in Catalonia. Sedation/monitoring and regional anesthesia are the approaches that predominate in this category. Ambulatory anesthesia is applied mainly in ophthalmology and the rate of endoscopic procedures requiring outpatient anesthesia is also high.

Background and Objective: The aim of this arm of the ANESCAT study was to analyze the characteristics of patients who underwent anesthesia for surgical procedures in Catalonia, Spain, in 2003., Patients and Method: Based on data obtained from the survey undertaken in 131 hospitals, we describe the anesthesia practice associated with surgical specialties, excluding anesthesia performed for obstetric and nonsurgical procedures. Data are provided for all surgical procedures and for each surgical specialty separately. The results are expressed as medians (10th-90th percentile)., Results: Surgical anesthesia represented 78.4% of anesthesia practice, corresponding to an estimated 472,857 anesthetic procedures per year. The most common surgical specialties associated with anesthetic procedures were orthopedics and traumatology (23.8%), ophthalmology (20.2%), general and digestive surgery (18.9%), and gynecology (9.7%). The median duration of anesthesia was 60 (25-165) minutes. The physical status of the patients according to the American Society of Anesthesiologists (ASA) classification was as follows: ASA 1, 37.9%; ASA 2, 32.5%; ASA 3, 23.9%; and ASA 4 or higher, 5.7%. The median age of the patients was 52 (21-78) years. Ambulatory procedures accounted for 33.6% of the total, and 9.2% of patients were admitted to postoperative critical care units. The most common procedure was cataract extraction (estimated 76,963 cases) followed by inguinal herniorrhaphy (23,315). Public hospitals performed 74.4% of all anesthetic procedures. Ophthalmology and plastic surgery were the most common procedures requiring anesthesia in private hospitals., Conclusions: Three out of 4 anesthetic procedures performed in Catalonia in 2003 was for surgery, 1 in 3 of those procedures was ambulatory, and almost 1 in 10 patients required postoperative critical care.