Impact of Surgical Experience on Operative Mortality After Reoperative Cardiac Surgery

Moon, Marc R.; Henn, Matthew C.; Maniar, Hersh S.; Pasque, Michael K.; Melby, Spencer J.; Kachroo, Puja; Masood, Muhammad; Itoh, Aki; Kotkar, Kunal; Munfakh, Nabil A.; Damiano, Ralph J.

doi:10.1016/j.athoracsur.2020.04.077

Cited by 19 publications

(13 citation statements)

References 16 publications

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“…Ensuring early career surgeons see cases of different preoperative risk and complexity is likely to be an important feature of comprehensive competency. On the contrary, some reports have shown that middle to late‐career surgeons obtain the best patient outcomes on complex operations, 1,3 which may argue for distribution of cases in which the more experienced surgeons receive more of the high‐risk cases to optimize patient outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Another study of vascular surgeons showed that surgeons within their first 5 years of practice had a greater proportion of nonelective cases with a higher degree of comorbidities and larger aneurysms 11 . In cardiac surgery, the only study to our knowledge which has looked at this relationship was done by Moon et al, 1 whose focus was reoperative cardiac surgery. Their study found a slightly higher EMR for patients of younger surgeons compared to older surgeons.…”

Section: Discussionmentioning

confidence: 99%

“…Several surgeon‐related factors are known to be associated with surgical outcomes. Surgeon years in practice is one of these factors, with some reports suggesting a concave relationship on complex cases, in which patient outcomes of early‐career surgeons improve for the first number of years in practice, stabilize for the middle of their career, and finally decline for very late‐career surgeons 1–4 . Such findings may suggest the importance of triaging cases of different complexity to surgeons of different experience levels.…”

Section: Introductionmentioning

confidence: 99%

“…In cardiac surgery, a prior study showed that surgeons with lower risk‐adjusted mortality rates tended to perform CABG surgery on higher risk patients 8 . Additionally, it has been shown that experienced surgeons with 9–17 years in practice may perform best on highly complex reoperative cases 1 . However, it is unknown if complex cases are distributed in a way that would optimize patient care in light of this observed trend.…”

Section: Introductionmentioning

confidence: 99%

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The relationship between cardiac surgeon experience and average patient risk profile: CA and NY statewide analysis

et al. 2021

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Background It is unknown how high and low‐risk cases are distributed among cardiac surgeons of different experience levels. The purpose of this study was to determine if high and low‐risk coronary artery bypass grafting (CABG) cases are distributed among surgeons in such a way that would optimize outcomes in light of recent studies that show mid‐career surgeons may obtain better patient outcomes on more complex cases. Methods We performed a cross‐sectional study using aggregated New York (NY) and California (CA) statewide surgeon‐level outcome data, including 336 cardiac surgeons who performed 43,604 CABGs. The surgeon observed and expected mortality rates (OMR and EMR) were collected and the number of years‐in‐practice was determined by searching for surgeon training history on online registries. Loess and linear regression models were used to characterize the relationship between surgeon EMR and surgeon years‐in‐practice. Results The median number of surgeon years‐in‐practice was 20 (interquartile range [IQR] 11–28) with a median annual case volume of 46 (IQR 19, 70.25). The median surgeon observed to expected mortality (O:E) ratio was 0.87 (IQR 0.19–1.4). Median EMR for CA surgeons was 2.42% and 1.44% for NY surgeons. Linear regression models showed EMR was similar across years in practice. Regression models also showed surgeon O:E ratios were similar across years‐in‐practice. Conclusion High and low‐risk CABG cases are relatively equally distributed among surgeons of differing experience levels. This equal distribution of high and low‐risk cases does not reflect a triaging of more complex cases to more experienced surgeons, which prior research shows may optimize patient outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The relationship between cardiac surgeon experience and average patient risk profile: CA and NY statewide analysis

et al. 2021

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show abstract

“…Several surgeon-related factors are known to be associated with surgical outcomes. Surgeon years in practice is one of these factors, with some reports suggesting a concave relationship on complex cases, in which outcomes of early-career surgeons improve for the first number of years in practice, stabilize for the middle of their career, and finally decline for very late career surgeons [1][2][3] . Such findings may suggest the importance of triaging cases of different complexity to surgeons of different experience levels.…”

Section: Introductionmentioning

confidence: 99%

The Relationship Between Cardiac Surgeon Experience and Patient Complexity: CA and NY statewide analysis

Weininger

Einarsson

Mori

et al. 2020

Preprint

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Background: Complex cardiac operations may have better outcomes when performed by mid-career surgeons compared with surgeons in early or late stages of their career. However, it is unknown how cardiac case complexities are distributed among surgeons of different experience levels. Methods: We performed a cross-sectional study using New York (NY) and California (CA) statewide surgeon-level coronary artery bypass grafting (CABG) outcome data, including 336 cardiac surgeons who performed 43,604 CABGs. Surgeon-level data including observed mortality rate (OMR) and expected mortality rates (EMR) was collected from 2014-2016 in NY and 2015-2016 in CA. Surgeons' number of years-in-practice was determined by searching for each surgeon's training history on online registries. Loess and linear regression models were then used to characterize the relationship between surgeon EMR and surgeon years-in-practice. Results: The median number of surgeon years-in-practice was 20 (interquartile range [IQR] 11-28) with median case volume 103 (IQR 42,171). The median surgeon observed to expected mortality (O:E) ratio was 0.87 (IQR 0.19-1.4). Linear regression relating EMR to years in practice showed that EMR was similar across years in practice. Linear regression relating surgeon isolated CABG O:E ratio to years in practice also showed similar outcomes across years in practice. Conclusion: There is a relatively equal distribution of high and low risk CABG cases among surgeons of differing experience levels. This equal distribution of high and low risk cases does not reflect a triaging of more complex cases to more experienced cardiac surgeons, which prior research shows may optimize patient outcomes.

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Advancing age in medicine—bane or boon?

Yadava

2020

Indian J Thorac Cardiovasc Surg

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Impact of Surgical Experience on Operative Mortality After Reoperative Cardiac Surgery

Cited by 19 publications

References 16 publications

The relationship between cardiac surgeon experience and average patient risk profile: CA and NY statewide analysis

The relationship between cardiac surgeon experience and average patient risk profile: CA and NY statewide analysis

The Relationship Between Cardiac Surgeon Experience and Patient Complexity: CA and NY statewide analysis

Advancing age in medicine—bane or boon?

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