Abstract
More than half of US cardiothoracic surgeons are older than 55 years, and the association between surgeon number of years in practice and surgical outcomes remains unclear. To assess the association between cardiac surgeons' time in practice and operative outcomes for coronary artery bypass grafting (CABG) and valve surgery. Cross-sectional analysis performed of surgeon-level outcomes data from the 2014-2016 New York State Cardiac Data Reporting System across the 38 New York cardiac surgery centers. Years in practice were characterized as early career (<10 years) and late career (≥10 years). Participants were 120 cardiothoracic surgeons who performed CABG and 112 cardiothoracic surgeons who performed valve procedures between 2014 and 2016. Data were analyzed in April 2020. Surgeons who trained outside of the United States or had unclear training history were excluded. Risk-adjusted operative mortality rate (RAMR). Mortality was defined as all-cause death within 30 days of surgery or within the index hospitalization, whichever was longer. Risk adjustment was performed by a multivariable risk model developed by the New York State Department of Public Health. Restricted cubic spline curve identified the association between risk-adjusted mortality rate and surgeon number of years in practice. Linear regression models adjusted for surgeons' annual case volumes. A total of 112 CABG surgeons and 120 valve surgeons performed 39 436 CABG and 18 596 valve procedures between 2014 and 2016. The median number of surgeon years in practice was 20.0 (interquartile range [IQR], 12.0-28.5) years. The median surgeon annual case volume was 160.0 (IQR, 92.5-245.0) for CABG procedures and 104.0 (IQR, 43.0-210.0) for valve procedures. The median RAMR was 1.3% (IQR, 0.2%-2.2%) for CABG procedures and 3.1% (IQR, 1.7%-5.1%) for valve procedures. Surgeons with less than 10 years of practice had higher RAMR for valve procedures compared with surgeons with more than 10 years of practice (4.0 [IQR, 1.5-7.7] vs 2.9 [IQR, 1.7-4.7]; P = .20), but the finding was not statistically signficant. The RAMR for surgeons with less than 10 years of practice was similar compared with surgeons with more than 10 years of practice for CABG procedures (1.3 [IQR, 0.3-2.1] vs 1.3 [IQR, 0.0-2.2]; P = .73). A lower number of years in practice was significantly associated with higher RAMR for valve procedures (RAMR estimates for linear term: -1.144; 95% CI, -1.955 to -0.332; P = .006; quadratic term: 0.059; 95% CI, 0.015 to 1.102; P = .008; and cubic term: -0.001; 95% CI, -0.002 to 0.000; P = .01). This association was not observed for CABG. In this cross-sectional study, compared with late-career cardiac surgeons, early-career cardiac surgeons were associated with worse risk-adjusted outcomes for valve operations but not for CABG. This finding suggests certain competence deficiency for valve surgery early after finishing training in cardiac surgery.
Highlights
IntroductionThe association between surgeon experience and operative outcomes has been the subject of debate, with some studies suggesting worse outcomes with increasing surgeon age,[1,2,3] while others report the opposite.[4,5] A concave association, in which outcomes improve for the first number of years a surgeon is in practice, plateau for a long period and worsen when surgeons approach retirement has been reported.[3,6] Many of these studies have used surgeon age, which may be confounded by various factors, including different training pathways and medical school starting age, as a surrogate for surgeon experience.[4,7,8,9] A few studies have used years in practice, which measures surgeon experience more precisely.[3,5]
Surgeons with less than 10 years of practice had higher Risk-adjusted operative mortality rate (RAMR) for valve procedures compared with surgeons with more than 10 years of practice (4.0 [interquartile range (IQR), 1.5-7.7] vs 2.9 [IQR, 1.7-4.7]; P = .20), but the finding was not statistically signficant
A lower number of years in practice was significantly associated with higher RAMR for valve procedures (RAMR estimates for linear term: −1.144; 95% CI, −1.955 to −0.332; P = .006; quadratic term: 0.059; 95% CI, 0.015 to 1.102; P = .008; and cubic term: −0.001; 95% CI, −0.002 to 0.000; P = .01)
Summary
The association between surgeon experience and operative outcomes has been the subject of debate, with some studies suggesting worse outcomes with increasing surgeon age,[1,2,3] while others report the opposite.[4,5] A concave association, in which outcomes improve for the first number of years a surgeon is in practice, plateau for a long period and worsen when surgeons approach retirement has been reported.[3,6] Many of these studies have used surgeon age, which may be confounded by various factors, including different training pathways and medical school starting age, as a surrogate for surgeon experience.[4,7,8,9] A few studies have used years in practice, which measures surgeon experience more precisely.[3,5] Most findings on this topic are based on investigations of general surgery cases. Valve surgery carries a higher risk profile than CABG and is more often performed by more experienced surgeons.[9,10] With more than half of the US cardiothoracic surgeons older than 55 years and nearing retirement,[11] understanding this association is timely
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
