The Relationship Between Cardiac Surgeon Experience and Patient
Complexity: CA and NY statewide analysis
Abstract
Background: Complex cardiac operations may have better outcomes when
performed by mid-career surgeons compared with surgeons in early or late
stages of their career. However, it is unknown how cardiac case
complexities are distributed among surgeons of different experience
levels. Methods: We performed a cross-sectional study using New York
(NY) and California (CA) statewide surgeon-level coronary artery bypass
grafting (CABG) outcome data, including 336 cardiac surgeons who
performed 43,604 CABGs. Surgeon-level data including observed mortality
rate (OMR) and expected mortality rates (EMR) was collected from
2014-2016 in NY and 2015-2016 in CA. Surgeons’ number of
years-in-practice was determined by searching for each surgeon’s
training history on online registries. Loess and linear regression
models were then used to characterize the relationship between surgeon
EMR and surgeon years-in-practice. Results: The median number of surgeon
years-in-practice was 20 (interquartile range [IQR] 11-28) with
median case volume 103 (IQR 42,171). The median surgeon observed to
expected mortality (O:E) ratio was 0.87 (IQR 0.19-1.4). Linear
regression relating EMR to years in practice showed that EMR was similar
across years in practice. Linear regression relating surgeon isolated
CABG O:E ratio to years in practice also showed similar outcomes across
years in practice. Conclusion: There is a relatively equal distribution
of high and low risk CABG cases among surgeons of differing experience
levels. This equal distribution of high and low risk cases does not
reflect a triaging of more complex cases to more experienced cardiac
surgeons, which prior research shows may optimize patient outcomes.