Journal article
Association Among Surgeon Experience, Patient Risk, and Outcomes in Coronary Artery Bypass Grafting
The Annals of thoracic surgery, v 111(1), pp 86-93
Jan 2021
PMID: 32544454
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
There is an association between surgeon experience and outcomes after cardiac surgery. However, this association is not well studied in the context of patient risk. The purpose of this single-center, retrospective, observational study was to describe how surgeon experience relates to patient risk in isolated coronary artery bypass grafting (CABG) surgery and how this impacts patient outcomes.
Surgeon experience was defined as time between the surgeon finishing fellowship and date of the patient’s surgery. Society of Thoracic Surgeons (STS) Predicted Risk of Mortality (PROM) was used to define patient risk. The Kaplan-Meier method was used to calculate long-term survival, and multivariable Cox proportional hazards regression was used to determine the effect of surgeon experience on survival.
Between 2002 and 2018, 7652 patients underwent isolated CABG. STS PROM was 1.35% (interquartile range [IQR], 0.70%-2.80%), 1.55% (IQR, 0.79%-3.34%), 1.78% (IQR, 0.84%-3.84%), and 1.19% (IQR, 0.62%-2.41%) in surgeon experience quartiles 1 (0.01-6.05 years), 2 (6.05-11.5 years), 3 (11.5-16.6 years), and 4 (16.6-32.1 years), respectively (P < .001). For patients in the lowest PROM quartile, Kaplan-Meier survival was similar across surgeon experience groups (P = .66). For patients in the highest PROM quartile, increasing surgeon experience was associated with better survival (P < .001). Cox regression identified surgeon experience as a protective factor (hazard ratio, 0.99, P = .027). In the least experienced surgeon group, increased ejection fraction was a protective factor for long-term survival (hazard ratio, 0.97; 95% confidence interval, 0.95-0.99).
Increasing surgeon experience is associated with higher-risk patients, but the most experienced surgeons take on lower-risk patients. Greater experience correlates with improved outcomes, especially with higher-risk cases.
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Details
- Title
- Association Among Surgeon Experience, Patient Risk, and Outcomes in Coronary Artery Bypass Grafting
- Creators
- Jason J. Han - Hospital of the University of PennsylvaniaMarkian M. Bojko - Drexel UniversityMatthew M. Duda - University of PennsylvaniaAmit Iyengar - Hospital of the University of PennsylvaniaJohn J. Kelly - Hospital of the University of PennsylvaniaWilliam L. Patrick - Hospital of the University of PennsylvaniaMark R. Helmers - Hospital of the University of PennsylvaniaPavan Atluri - Division of Cardiovascular Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
- Publication Details
- The Annals of thoracic surgery, v 111(1), pp 86-93
- Publisher
- Elsevier Inc
- Number of pages
- 8
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- College of Medicine
- Web of Science ID
- WOS:000605733800019
- Scopus ID
- 2-s2.0-85097330251
- Other Identifier
- 991021860755004721
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InCites Highlights
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Cardiac & Cardiovascular Systems
- Respiratory System
- Surgery