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The Relationship Between Cardiac Surgeon Experience and Patient Complexity: CA and NY statewide analysis
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  • Gabe Weininger,
  • Arnar Einarsson,
  • Makoto Mori,
  • Cornell Brooks,
  • Michael Shang,
  • Roland Assi,
  • Prashanth Vallabhajosyula,
  • Arnar Geirsson
Gabe Weininger
Yale School of Medicine
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Arnar Einarsson
Faculty of Medicine, School of Health Sciences, University of Iceland
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Makoto Mori
Yale University School of Medicine
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Cornell Brooks
Yale School of Medicine
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Michael Shang
Yale School of Medicine
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Roland Assi
Yale University School of Medicine
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Prashanth Vallabhajosyula
Yale School of Medicine
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Arnar Geirsson
Yale University School of Medicine
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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.

Peer review status:ACCEPTED

28 Oct 2020Submitted to Journal of Cardiac Surgery
02 Nov 2020Submission Checks Completed
02 Nov 2020Assigned to Editor
04 Nov 2020Reviewer(s) Assigned
21 Nov 2020Review(s) Completed, Editorial Evaluation Pending
23 Nov 2020Editorial Decision: Revise Major
02 Dec 20201st Revision Received
04 Dec 2020Submission Checks Completed
04 Dec 2020Assigned to Editor
05 Dec 2020Reviewer(s) Assigned
21 Dec 2020Review(s) Completed, Editorial Evaluation Pending
26 Dec 2020Editorial Decision: Accept