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Observations on Surgeons' Case Selection, Morbidity, and Mortality Following Board Certification
Christopher A Guidry1, Timothy E Newhook, Florence E Turrentine
1*Department of Surgery, Charlottesville, VA †Division of Patient Outcomes, Policy and Population Research, Department of Public Health Sciences, Charlottesville, VA ‡Division of Acute Care Surgery and Outcomes Research, The University of Virginia Health System, Charlottesville, VA.
Surgeons adjust patient selection based on experience, initially taking on higher-risk cases. Experienced surgeons (over 25 years) show lower complication rates but no change in mortality.
Area of Science:
- Surgical outcomes research
- Health services research
Background:
- Surgeon and hospital volume correlate with surgical outcomes.
- Temporal experience measures often show no effect on outcomes.
- Self-reported case complexity decreases over a surgeon's career.
Purpose of the Study:
- To investigate if patient selection strategies change with a surgeon's years of practice.
- To determine the association between surgical experience and patient preoperative risk.
Main Methods:
- Analysis of 18,688 general surgery cases from a tertiary care center (10-year period).
- Utilized American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) data.
- Employed multivariate linear regression to assess the relationship between years of experience post-certification and complication/mortality risk.
Main Results:
- Surgeons initially selected higher-risk patients, peaking around 15 years of practice.
- Patient risk selection decreased after 15 years of surgical experience.
- No significant association found between years of experience and mortality after risk adjustment.
- A trend towards decreasing complication rates was observed with increased surgical experience.
Conclusions:
- Surgical experience significantly influences patient selection criteria.
- Surgeons with over 25 years of experience demonstrated lower complication rates.
- Surgical experience did not impact patient mortality rates.
