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Updated: May 17, 2026
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Published on: February 10, 2022
Cumulative team experience matters more than individual surgeon experience in cardiac surgery
Andrew W Elbardissi1, Antoine Duclos, James D Rawn
1Center for Surgery and Public Health, Brigham & Women's Hospital, Boston, MA, USA. aelbardissi@post.harvard.edu
Insights
Team experience, not individual surgeon skill, significantly improves efficiency in coronary artery bypass graft (CABG) surgery. Collaborative learning between attending surgeons and fellows dramatically reduces procedure times, highlighting the importance of team dynamics for surgical efficiency.
Area of Science:
- Cardiovascular Surgery
- Surgical Education
- Health Services Research
Background:
- Surgical efficiency in coronary artery bypass graft (CABG) procedures is influenced by surgeon experience.
- Both individual surgeon expertise and team collaboration are considered crucial factors.
Purpose of the Study:
- To quantitatively assess the impact of individual attending surgeon experience and the cumulative experience of attending surgeon-cardiothoracic fellow pairs on CABG procedure efficiency.
- To determine the relative contributions of individual versus collaborative experience to operative times.
Main Methods:
- Retrospective analysis of a prospectively collected database of 4068 isolated CABG procedures (2001-2010).
- Multivariate generalized estimating equation regression models were used to adjust for patient risk.
- Evaluated the association between attending surgeon experience (post-fellowship) and the number of prior attending-fellow collaborations with cardiopulmonary bypass and crossclamp times.
Main Results:
- Both increased attending surgeon experience and a higher number of prior attending-fellow collaborations were significantly associated with reduced cardiopulmonary bypass and crossclamp times (P < .001).
- The impact of attending-fellow pair experience on reducing operative times was nearly three times greater than that of individual attending surgeon experience.
- Mean attending experience was 10.9 years; mean unique pair collaborations were 10.0 cases.
Conclusions:
- Cumulative experience within attending surgeon-cardiothoracic fellow teams significantly enhances operative efficiency in CABG surgery.
- Individual surgeon learning curves after fellowship appear to have a clinically insignificant impact on efficiency.
- Team-based collaborative experience is the primary driver of operative efficiency in CABG procedures, rather than individual surgeon seniority.
Objectives:
Individual surgeon experience and the cumulative experience of the surgical team have both been implicated as factors that influence surgical efficiency. We sought to quantitatively evaluate the effects of both individual surgeon experience and the cumulative experience of attending surgeon-cardiothoracic fellow collaborations in isolated coronary artery bypass graft (CABG) procedures.
Methods:
Using a prospectively collected retrospective database, we analyzed all medical records of patients undergoing isolated CABG procedure at our institution. We used multivariate generalized estimating equation regression models to adjust for patient mix and subsequently evaluated the effect of both attending cardiac surgeon experience (since fellowship graduation) and the number of previous collaborations between attending cardiac surgeons and cardiothoracic fellow pairs on cardiopulmonary bypass and crossclamp times.
Results:
From 2001 to 2010, 4068 consecutive patients underwent isolated CABG procedure at our institution performed by 11 attending cardiac surgeons and 73 cardiothoracic fellows. Mean attending experience after fellowship graduation was 10.9 ± 8.0 years and mean number of cases between unique pairs of attending cardiac surgeons and cardiothoracic fellows was 10.0 ± 10.0 cases. After patient risk adjustment, both attending surgical experience since fellowship graduation and the number of previous collaborations between attending surgeons and cardiothoracic fellows were significantly associated with a reduction in cardiopulmonary bypass and crossclamp times (P < .001). The influence of attending-fellow pair experience far exceeded the influence of surgical experience with beta estimates for attending-fellow pair experience nearly three times that of attending surgeon experience.
Conclusions:
Cumulative experience of attending cardiac surgeons and cardiothoracic fellows has a dramatic effect on both cardiopulmonary bypass and crossclamp times, whereas attending cardiac surgeon learning curves following fellowship graduation are clinically insignificant. Taken together, these findings suggest that the primary driver of operative efficiency in CABG procedure is the collaborative experience of the attending surgeon-cardiothoracic fellow operative team, rather than the individual experience of the attending surgeon.