Abstract 19400: The Impact of Surgeon Experience on Congenital Heart Surgery Outcomes
Introduction: Surgeon experience concerns both families of children with congenital heart disease and their medical providers. Relationships between surgeon seniority and their patients’ outcomes are often assumed, yet there is little data regarding the associations between surgeon experience and outcomes for these children.
Hypothesis: Congenital heart surgeon years of experience is associated with patient outcomes.
Methods: This retrospective 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 or mortality for children (age <18 years) undergoing cardiac surgery. Sensitivity analyses explored different transformations of surgeon experience and adjusted for patient characteristics, institutional/surgeon volumes, and various measures of experience for each institution’s surgical team.
Results: We identified 206 congenital heart surgeons at 91 centers, performing 62,851 index operations (2010-2014). Median time from medical school was 25 years (range 9-55). A major morbidity or mortality occurred in 11.5% of cases. In multivariable analyses, the odds of major morbidity or mortality were similar for young (<15 years from medical school), mid-career (15-24 years), and senior surgeons (25-35 years). The odds of major morbidity or mortality were ~25% higher for operations performed by very senior surgeons (35-55 years from school, n=9,044 cases). In extensive sensitivity analyses, this effect remained constant.
Conclusions: In this study of >200 congenital heart surgeons, surgeon years of experience was not associated with patient outcomes for junior surgeons. Very senior surgeons, however, had significantly higher risk-adjusted odds of major morbidity or mortality. Contemporary approaches to training, referral, mentoring, surgical planning, and/or other support practices might contribute to the ability of junior congenital heart surgeons to achieve outcomes comparable to their more experienced colleagues. Understanding and disseminating these practices might benefit the medical community at large.
- Quality assessment
- Congenital heart surgery, pediatric
- Congenital heart disease
- Health services research
Author Disclosures: B.R. Anderson: Research Grant; Significant; KL2 TR000081. A.S. Wallace: None. K.D. Hill: Research Grant; Significant; KL2TR001115-02, Gilead Sciences Cardiovascular scholars program. B.C. Gulack: None. R. Matsouaka: None. J.P. Jacobs: Consultant/Advisory Board; Modest; Chair of STS Public Reporting Task Force. E.A. Bacha: None. S.A. Glied: None. M.L. Jacobs: None.
- © 2016 by American Heart Association, Inc.