Journal article
Association of Acute Care Surgeon Experience With Emergency Surgery Patient Outcomes and Mortality
JAMA surgery, Vol.156(5), pp.472-478
01 May 2021
PMID: 33688932
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
IMPORTANCE Previous studies comparing emergency surgery outcomes with surgeon experience have been small or used administrative databases without controlling for patient physiology or operative complexity.
OBJECTIVE To evaluate the association of acute care surgeon experience with patient morbidity and mortality after emergency surgical procedures.
DESIGN, SETTING, AND PARTICIPANTS This cohort study evaluated the association of surgeon experience with emergency surgery outcomes at 5 US academic level 1 trauma centers where the same surgeons provided emergency general surgical care. A total of 772 patients who presented with a traumatic injury and required an emergency surgical procedure or who presented with or developed a condition requiring an emergency general surgical intervention were operated on by 1 of 56 acute care surgeons. Surgeon groups were divided by experience of less than 6 years (early career), 6 to 10 years (early midcareer), 11 to 30 years (late midcareer), and 30 years or more (late career) from the end of training. Surgeons with less than 3 years of experience were also compared with the entire cohort. Hierarchical logistic regression models were constructed controlling for Emergency Surgery Score, case complexity, preoperative transfusion, and trauma or emergency general surgery. Data were collected from May 2015 to July 2017 and analyzed from February toMay 2020.
MAIN OUTCOMES AND MEASURES Mortality, complications, length of stay, blood loss, and unplanned return to the operating room.
RESULTS Of 772 included patients, 469 (60.8%) were male, and the mean (SD) age was 50.1 (20.0) years. Of 772 operations, 618 were by surgeons with less than 10 years of experience. Early- and late-midcareer surgeons generally operated on older patients and patients with more septic shock, acute kidney failure, and higher Emergency Surgery Scores. Patient mortality, complications, postoperative transfusion, organ-space surgical site infection, and length of stay were similar between surgeon groups. Patients operated on by early-career surgeons had higher rates of unplanned return to the operating room compared with those operated on by early-midcareer surgeons (odds ratio [OR], 0.66; 95% CI, 0.40-1.09), late-midcareer surgeons (OR, 0.34; 95% CI, 0.13-0.90), and late-career surgeons (OR, 1.11; 95% CI, 0.45-2.75). Patients operated on by surgeons with less than 3 years of experience had similar mortality compared with the rest of the cohort (OR, 1.97; 95% CI, 0.85-4.57) but higher rates of complications (OR, 2.07; 95% CI, 1.05-4.07).
CONCLUSIONS AND RELEVANCE In this study, experienced surgeons generally operated on older patients with more septic shock and kidney failure without affecting risk-adjusted mortality. Increased complications and unplanned return to the operating room may improve with experience. Early-career surgeons' outcomesmay be improved if they are supported while experience is garnered.
Metrics
1 Record Views
Details
- Title
- Association of Acute Care Surgeon Experience With Emergency Surgery Patient Outcomes and Mortality
- Creators
- Kevin M. Schuster - Yale UniversityJoshua P. Hazelton - Penn State Milton S. Hershey Medical CenterDeviney Rattigan - Cooper University HospitalJavier Martin Perez - Hackensack University Medical CenterBishwajit Bhattacharya - Yale University
- Publication Details
- JAMA surgery, Vol.156(5), pp.472-478
- Publisher
- Amer Medical Assoc
- Number of pages
- 7
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Surgery
- Web of Science ID
- WOS:000627902300005
- Scopus ID
- 2-s2.0-85102476646
- Other Identifier
- 991022056905104721
UN Sustainable Development Goals (SDGs)
This output has contributed to the advancement of the following goals:
InCites Highlights
These are selected metrics from InCites Benchmarking & Analytics tool, related to this output
- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Surgery