Data source
The Yale institutional review board waived approval and the need for
patient consent since the datasets are publicly available. The data was
obtained from the publicly available 2014-2016 New York State Cardiac
Data Reporting System and 2015-2016 California Report on CABG
Surgery8,9. Both of these states have mandatory public
reporting systems for surgeon-level cardiac surgery outcome data. We
collected observed mortality rate (OMR) and expected mortality rate
(EMR) for isolated CABG in both states. EMR is calculated from
multivariable risk models developed by the New York State Department of
Public Health and California CABG Outcomes Reporting Program, both of
which account for various patient demographics and
comorbidities8,9. Some of these demographics and
comorbidities include ejection fraction, previous MI, cardiogenic shock,
previous cardiac surgery or PCI, renal failure, liver disease,
peripheral vascular disease, endocarditis, BMI, and
others8,9. Based on these multivariable risk models,
EMR captures the average risk profile of a surgeon’s cases. Operative
mortality for both states is defined as death within 30-days from
surgery or within the index hospitalization.
We determined surgeons’ number of years in practice by collecting each
surgeon’s training history from The Cardiothoracic Surgery Network
(CTSnet, ctsnet.org). Each surgeon’s final year of schooling was
subtracted from 2016 (the latest year captured in the New York and
California data) to determine number of years in practice. For surgeons
whose training history was not listed on CTSnet, we searched other
online resources including the website of the surgeon’s current hospital
and healthgrades.com. International medical graduates (IMGs) were
excluded from the study because IMGs may have practiced as surgeons
overseas, which may have obscured the actual years in practice. We
combined surgeon-level outcomes for individual surgeons practicing at
multiple hospitals.