Abstract
SummaryIt is widely accepted that the performance of the operating surgeon affects outcomes, and this has led to the publication of surgical results in the public domain. However, the effect of other members of the multidisciplinary team is unknown. We studied the effect of the anaesthetist on mortality after cardiac surgery by analysing data collected prospectively over ten years of consecutive cardiac surgical cases from ten UK centres. Casemix‐adjusted outcomes were analysed in models that included random‐effects for centre, surgeon and anaesthetist. All cardiac surgical operations for which the EuroSCORE model is appropriate were included, and the primary outcome was in‐hospital death up to three months postoperatively. A total of 110 769 cardiac surgical procedures conducted between April 2002 and March 2012 were studied, which included 127 consultant surgeons and 190 consultant anaesthetists. The overwhelming factor associated with outcome was patient risk, accounting for 95.75% of the variation for in‐hospital mortality. The impact of the surgeon was moderate (intra‐class correlation coefficient 4.00% for mortality), and the impact of the anaesthetist was negligible (0.25%). There was no significant effect of anaesthetist volume above ten cases per year. We conclude that mortality after cardiac surgery is primarily determined by the patient, with small but significant differences between surgeons. Anaesthetists did not appear to affect mortality. These findings do not support public disclosure of cardiac anaesthetists' results, but substantially validate current UK cardiac anaesthetic training and practice. Further research is required to establish the potential effects of very low anaesthetic caseloads and the effect of cardiac anaesthetists on patient morbidity.
Highlights
It is accepted that the operating surgeon may affect risk-adjusted mortality following cardiac surgery, and this has led to the publication of surgeon-specific mortality rates in the UK and elsewhere [1, 2]
All centres collected data prospectively as part of NHS requirements and provided these data to the Society of Cardiothoracic Surgeons and National Institute for Cardiovascular Outcomes Research; these datasets were provided to the Association of Cardiothoracic Anaesthetists (ACTA) in 2014
The logistic EuroSCORE was used to adjust for different patient casemix; this is a very well-established risk score, given as a percentage, constructed to be used as a risk predictor for in-hospital death after cardiac operations. It includes 17 cardiac, operation- and patient-related factors and is used for risk assessment in many countries. This is the principal patient covariate we considered and it should be sufficient since all important patientrelated factors for in-hospital mortality were included in its construction, with appropriate weighting [13, 14]
Summary
It is accepted that the operating surgeon may affect risk-adjusted mortality following cardiac surgery, and this has led to the publication of surgeon-specific mortality rates in the UK and elsewhere (see http:// www.scts.org/patients/hospitals/) [1, 2]. The fact that cardiac surgery is undertaken by teams has inevitably led to the suggestion that other team members – notably the anaesthetist – should be subject to similar scrutiny, and that anaesthetist-specific, risk-adjusted outcomes should be available [3,4,5,6]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
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 callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
