Cardiothoracic surgeons with less than 10 years of experience are associated with worse valve surgery outcomes, according to a new analysis published in JAMA Network Open. Is this a sign that surgeons aren’t receiving the training they need?
“The association between surgeon experience and operative outcomes has been the subject of debate, with some studies suggesting worse outcomes with increasing surgeon age, while others report the opposite,” wrote lead author Gabe Weininger, BS, division of cardiac surgery at Yale University School of Medicine in New Haven, Connecticut, and colleagues. “A concave association, in which outcomes improve for the first number of years a surgeon is in practice, then plateau for a long period and worsen when surgeons approach retirement has also been reported.”
Weininger’s team focused specifically on coronary artery bypass grafting (CABG) procedures and valve surgeries, tracking data from 120 cardiothoracic surgeons who performed CABG procedures and an additional 112 who performed valve procedures. Transcatheter procedures were excluded from the analysis.
All surgeries occurred from 2014 to 2016 at one of 38 surgery centers in the state of New York. Surgeons were divided into two groups: those with fewer than ten years of experience and those with at least ten years of experience.
Overall, the median risk-adjusted operative mortality rate (RAMR) was 1.3% for CABG procedures and 3.1% for valve procedures. Surgeons with fewer than ten years of experience had a median RAMR rate of 4.0 for valve procedures. More experienced surgeons, on the other hand, had a median RAMR rate of 2.9 for valve procedures. For both groups, the median RAMR rate for CABG procedures was 1.3.
Having less experience, the authors added, “was significantly associated with higher RAMR for valve procedures,” but “this association was not observed for CABG.”
Weininger et al. reflected on their findings, writing that this may be the first time this specific distinction between CABG outcomes and valve surgery outcomes has been reported. Mortality is typically much higher for valve surgeries than CABG, they added, which made this discovery a bit of a surprise.
“Worse valve surgery outcomes for early-career surgeons may indicate the need for exposure to complex valve operations during training and appropriate supervision on patient selection and referrals during early years of clinical practice,” the authors wrote. “In contrast, the lack of association between CABG outcome and surgeon years in practice suggests that current training models adequately prepare early-career surgeons to perform CABG.”
Perhaps current cardiac surgery training programs should focus more on “complex valve operations,” they added. The team also suggested that more experienced surgeons could work alongside those with less experience.
Read the full analysis here.
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.