Surgeon length of service and risk-adjusted outcomes: linked observational analysis of the UK National Adult Cardiac Surgery Audit Registry and General Medical Council Register
| Autor: | Graeme L. Hickey, Stuart W Grant, David Cunningham, Iain Buchan, Ben Bridgewater, Christopher M. Munsch, Nick Freemantle, Steven A Livesey, James Roxburgh |
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| Rok vydání: | 2014 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Consultants Logistic regression Risk Assessment Physicians Odds Ratio Humans Medicine Hospital Mortality Registries Cardiac Surgical Procedures Coronary Artery Bypass Aged Retrospective Studies Medical Audit business.industry Research Mortality rate General surgery Thoracic Surgery Retrospective cohort study EuroSCORE General Medicine Odds ratio Middle Aged medicine.disease Heart Valves United Kingdom Cardiac surgery Logistic Models Cardiothoracic surgery Female Clinical Competence Medical emergency business Risk assessment |
| Zdroj: | Journal of the Royal Society of Medicine. 107:355-364 |
| ISSN: | 1758-1095 0141-0768 |
| Popis: | Summary Objectives To explore the relationship between in-hospital mortality following adult cardiac surgery and the time since primary clinical qualification for the responsible consultant cardiac surgeon (a proxy for experience). Design Retrospective analysis of prospectively collected national registry data over a 10-year period using mixed-effects multiple logistic regression modelling. Surgeon experience was defined as the time between the date of surgery and award of primary clinical qualification. Setting UK National Health Service hospitals performing cardiac surgery between January 2003 and December 2012. Participants All patients undergoing coronary artery bypass grafts and/or valve surgery under the care of a consultant cardiac surgeon. Main outcome measures All-cause in-hospital mortality. Results A total of 292,973 operations performed by 273 consultant surgeons (with lengths of service from 11.2 to 42.0 years) were included. Crude mortality increased approximately linearly until 33 years service, before decreasing. After adjusting for case-mix and year of surgery, there remained a statistically significant ( p = 0.002) association between length of service and in-hospital mortality (odds ratio 1.013; 95% CI 1.005–1.021 for each year of ‘experience’). Conclusions Consultant cardiac surgeons take on increasingly complex surgery as they gain experience. With this progression, the incidence of adverse outcomes is expected to increase, as is demonstrated in this study. After adjusting for case-mix using the EuroSCORE, we observed an increased risk of mortality in patients operated on by longer serving surgeons. This finding may reflect under-adjustment for risk, unmeasured confounding or a real association. Further research into outcomes over the time course of surgeon's careers is required. |
| Databáze: | OpenAIRE |
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