A realistic view of the cardiothoracic surgery specialty

Salerno, Tomás A.

doi:10.1590/s0102-76382002000400002

Cited by 4 publications

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“…The impact that catheterbased interventions has had on CABG procedural volumes has been significant enough to stimulate much discussion on the future of cardiothoracic surgery from the surgeons themselves. 32,33,[35][36][37][38] In an effort to institute measures which will ensure the viability of cardiothoracic surgery as a specialty it has been suggested that while surgeons should embrace new catheter-based interventions, they should not feel that it is beneath them to perform lesser procedures other than cardiac surgery. 32,33 Organisational issues including structures and practices were claimed to have prevented cardiothoracic surgeons from recognising and investing in catheter-based interventions as a disruptive technology, thus losing the "first mover advantage."…”

Section: Discussionmentioning

confidence: 99%

Global Trends in Cardiology and Cardiothoracic Surgery – An Opportunity or a Threat?

Molina

Heng

2009

Ann Acad Med Singap

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Coronary heart disease is currently the leading cause of death globally, and is expected to account for 14.2% of all deaths by 2030. The emergence of novel technologies from cardiothoracic surgery and interventional cardiology are welcome developments in the light of an overwhelming chronic disease burden. However, as these complementary yet often competing disciplines rely on expensive technologies, hastily prepared resource plans threaten to consume a substantial proportion of limited healthcare resources. By describing procedural and professional trends as well as current and emerging technologies, this review aims to provide useful knowledge to help managers make informed decisions for the planning of cardiovascular disease management. Since their inception, developments in both specialties have been very rapid. Owing to differences in patient characteristics, interventions and outcomes, results of studies comparing cardiothoracic surgery and interventional cardiology have been conflicting. Outcomes for both specialties continue to improve through the years. Despite the persistent demand for coronary artery bypass surgery (CABG) as a rescue procedure following percutaneous coronary intervention (PCI), there is a widening gap between the numbers of PCI and CABG. Procedural volumes seem to have affected career choices of physicians. Emerging technologies from both disciplines are eagerly awaited by the medical community. For long-term planning of both disciplines, conventional health technology assessment methods are of limited use due to their rapid developments. In the absence of established prediction tools, planners should tap alternative sources of evidence such as changes in disease epidemiology, procedural volumes, horizon scan reports as well as trends in disease outcomes. Key words: Cardiac surgery, Interventional cardiology, Planning

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Section: Discussionmentioning

confidence: 99%

Global Trends in Cardiology and Cardiothoracic Surgery – An Opportunity or a Threat?

Molina

Heng

2009

Ann Acad Med Singap

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“…Technological advances in cardiology and cardiac surgery, with the expanded use of modern percutaneous interventions, mechanical assist devices, minimally invasive and robotic surgery, and the use of hybrid and stenting procedures, led surgeons to have to leave the operating room and work in collaboration with cardiologists. 1 Brazilian cardiac surgeons have faced this reality and have modified their educational programs to meet the requirements for board certification eligibility, achieved via a comprehensive training and examination processes.…”

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confidence: 99%

Passing the torch: Let us make sure it remains lit

Macedo

Salerno

2018

The Journal of Thoracic and Cardiovascular Surgery

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“…CABG practice guidelines (Eagle et al 2004) show nearly a third of patient subsets has Class II indications without consensus on treatment. Salerno (2002, p. 384) notes how the turf war in the field has led to a decline in surgeon determination of interventions: “Perhaps even sadder is the fact that we have practically lost our patients [who] are fully worked up by the cardiologists and are referred to us for a specific operation, dictated by the cardiologists.”…”

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Learning by Doing, Scale Effects, or Neither? Cardiac Surgeons after Residency

Huesch

2009

Health Services Research

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Objective. To examine impacts of operating surgeon scale and cumulative experience on postoperative outcomes for patients treated with coronary artery bypass grafts (CABG) by ''new'' surgeons. Pooled linear, fixed effects panel, and instrumented regressions were estimated. Data Sources. The administrative data included comorbidities, procedures, and outcomes for 19,978 adult CABG patients in Florida in 1998-2006, and public data on 57 cardiac surgeons who completed residencies after 1997. Study Design. Analysis was at the patient level. Controls for risk, hospital scale and scope, and operating surgeon characteristics were made. Patient choice model instruments were constructed. Experience was estimated allowing for ''forgetting'' effects. Principal Findings. Panel regressions with surgeon fixed effects showed neither surgeon scale nor cumulative volumes significantly impacted mortality nor consistently impacted morbidity. Estimation of ''forgetting'' suggests that almost all prior experience is depreciated from one quarter to the next. Instruments were strong, but exogeneity of volume was not rejected. Conclusions. In postresidency surgeons, no persuasive evidence is found for learning by doing, scale, or selection effects. More research is needed to support the cautious view that, for these ''new'' cardiac surgeons, patient volume could be redistributed based on realized outcomes without disruption.

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A realistic view of the cardiothoracic surgery specialty

Cited by 4 publications

References 0 publications

Global Trends in Cardiology and Cardiothoracic Surgery – An Opportunity or a Threat?

Global Trends in Cardiology and Cardiothoracic Surgery – An Opportunity or a Threat?

Passing the torch: Let us make sure it remains lit

Learning by Doing, Scale Effects, or Neither? Cardiac Surgeons after Residency

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