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Association of Surgeon Age and Experience With Congenital Heart Surgery Outcomes.

Publication ,  Journal Article
Anderson, BR; Wallace, AS; Hill, KD; Gulack, BC; Matsouaka, R; Jacobs, JP; Bacha, EA; Glied, SA; Jacobs, ML
Published in: Circ Cardiovasc Qual Outcomes
July 2017

BACKGROUND: Surgeon experience concerns both families of children with congenital heart disease and medical providers. Relationships between surgeon seniority and patient outcomes are often assumed, yet there are little data. METHODS AND RESULTS: This national study used linked data from the American Medical Association Physician Masterfile and the Society of Thoracic Surgeons-Congenital Heart Surgery Database to examine associations between surgeon years since medical school and major morbidity/mortality for children undergoing cardiac surgery. Sensitivity analyses explored the effects of patient characteristics, institutional/surgeon volumes, and various measures of institutional surgeon team experience. In secondary analyses, major morbidity and mortality were examined as separate end points. We identified 206 congenital heart surgeons from 91 centers performing 62 851 index operations (2010-2014). Median time from school was 25 years (range 9-55 years). A major morbidity/mortality occurred in 11.5% of cases. In multivariable analyses, the odds of major morbidity/mortality were similar for early-career (<15 years from medical school, ≈<40 years old), midcareer (15-24 years, ≈40-50 years old), and senior surgeons (25-35 years, ≈50-60 years old). The odds of major morbidity/mortality were ≈25% higher for operations performed by very senior surgeons (35-55 years from school, ≈60-80 years old; n=9044 cases). Results were driven by differences in morbidity. In extensive sensitivity analyses, these effects remained constant. CONCLUSIONS: In this study of >200 congenital heart surgeons, we found patient outcomes for surgeons with the fewest years of experience to be comparable to those of their midcareer and senior colleagues, within the context of existing referral and support practices. Very senior surgeons had higher risk-adjusted odds of major morbidity/mortality. Contemporary approaches to training, referral, mentoring, surgical planning, and other support practices might contribute to the observed outcomes of junior congenital heart surgeons being comparable to those of more experienced colleagues. Understanding and disseminating these practices might benefit the medical community at large.

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Published In

Circ Cardiovasc Qual Outcomes

DOI

EISSN

1941-7705

Publication Date

July 2017

Volume

10

Issue

7

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Surgeons
  • Risk Factors
  • Registries
  • Quality Indicators, Health Care
  • Postoperative Complications
  • Odds Ratio
  • North America
  • Multivariate Analysis
 

Citation

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Anderson, B. R., Wallace, A. S., Hill, K. D., Gulack, B. C., Matsouaka, R., Jacobs, J. P., … Jacobs, M. L. (2017). Association of Surgeon Age and Experience With Congenital Heart Surgery Outcomes. Circ Cardiovasc Qual Outcomes, 10(7). https://doi.org/10.1161/CIRCOUTCOMES.117.003533
Anderson, Brett R., Amelia S. Wallace, Kevin D. Hill, Brian C. Gulack, Roland Matsouaka, Jeffrey P. Jacobs, Emile A. Bacha, Sherry A. Glied, and Marshall L. Jacobs. “Association of Surgeon Age and Experience With Congenital Heart Surgery Outcomes.Circ Cardiovasc Qual Outcomes 10, no. 7 (July 2017). https://doi.org/10.1161/CIRCOUTCOMES.117.003533.
Anderson BR, Wallace AS, Hill KD, Gulack BC, Matsouaka R, Jacobs JP, et al. Association of Surgeon Age and Experience With Congenital Heart Surgery Outcomes. Circ Cardiovasc Qual Outcomes. 2017 Jul;10(7).
Anderson, Brett R., et al. “Association of Surgeon Age and Experience With Congenital Heart Surgery Outcomes.Circ Cardiovasc Qual Outcomes, vol. 10, no. 7, July 2017. Pubmed, doi:10.1161/CIRCOUTCOMES.117.003533.
Anderson BR, Wallace AS, Hill KD, Gulack BC, Matsouaka R, Jacobs JP, Bacha EA, Glied SA, Jacobs ML. Association of Surgeon Age and Experience With Congenital Heart Surgery Outcomes. Circ Cardiovasc Qual Outcomes. 2017 Jul;10(7).

Published In

Circ Cardiovasc Qual Outcomes

DOI

EISSN

1941-7705

Publication Date

July 2017

Volume

10

Issue

7

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Surgeons
  • Risk Factors
  • Registries
  • Quality Indicators, Health Care
  • Postoperative Complications
  • Odds Ratio
  • North America
  • Multivariate Analysis