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New Surgeon Outcomes and the Effectiveness of Surgical Training: A Population-Based Cohort Study
Robert J Campbell1, Sherif R El-Defrawy2, Sudeep S Gill3
1Department of Ophthalmology, Queen's University, Kingston, Canada; Department of Ophthalmology, Hotel Dieu and Kingston General Hospitals, Kingston, Canada; Institute for Clinical Evaluative Sciences, Kingston, Canada.
Purpose:
Reports have questioned the technical proficiency of newly graduating surgeons. However, objective data supporting these concerns are limited. Surgical outcomes among recent graduates are an important indicator of residency programs' ability to graduate surgeons who are ready to meet the needs of their patients. This study aimed to investigate the association between a surgeon's number of years of independent practice and the risk of surgical adverse events.
Design:
Population-based cohort study.
Participants:
All patients 66 years of age or older undergoing isolated cataract operations in Ontario, Canada, between January 1, 1997, and December 31, 2013.
Methods:
Cataract surgical outcomes for all operations performed by surgeons commencing practice in the study period were evaluated using linked health care databases.
Main Outcome Measures:
Four serious complications were evaluated: posterior capsule rupture, dropped lens fragments, retinal detachment, and suspected endophthalmitis. Analyses controlled for patient-, surgeon-, and institution-level covariates.
Results:
The study evaluated 1 431 320 cataract operations. Surgeons in their first year of independent practice were more than 9 times more likely to have high complication rates (≥2%) than surgeons in their tenth year (odds ratio [OR], 9.3; 95% confidence interval [CI], 2.7-31.9). Each additional year of independent practice was associated with a 10% decrease in the risk of patients experiencing an adverse surgical event (OR, 0.90 per year of surgeon independent practice; 95% CI, 0.87-0.94).
Conclusions:
In this population-based study, surgical complications were significantly more likely early in surgeons' careers. Interventions may be needed in postgraduate surgical training and early independent career monitoring and mentoring processes to ensure patient safety while continually renewing the surgical workforce.
