Outcome differences between surgeons performing first and subsequent coronary artery bypass grafting procedures in a day: a retrospective comparative cohort study

Zhang, Dan‐Wei; Gu, Dachuan; Rao, Chenfei; Zhang, Heng; Su, Xiaoting; Chen, Sipeng; Ma, Hanping; Zhao, Yan; Feng, Wei; Sun, Hansong; Zheng, Zhe

doi:10.1136/bmjqs-2021-014244

Cited by 5 publications

(8 citation statements)

References 35 publications

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“…The extensive team-based nature of cardiac surgery starts in the operating room but extends to the postoperative phase as well, which should be considered when evaluating outcomes. In the study by Zhang and colleagues, the operating room team (anaesthesia, nursing and perfusion) did not change over the course of the day 5. Similar evaluation of task error should be performed for the whole team, not only the surgeon.…”

Section: Surgeon Versus System Errorsmentioning

confidence: 93%

“…In the study by Zhang and colleagues, the operating room team (anaesthesia, nursing and perfusion) did not change over the course of the day. 5 Similar evaluation of task error should be performed for the whole team, not only the surgeon. Alternative models include shift-based staffing, and comparison between these models could help clarify any potential workload or fatigue-based issues.…”

Section: Surgeon Versus System Errorsmentioning

confidence: 99%

“…16 The risk factors for conversions and incomplete revascularisation are similar and focus on patient anatomy, which is not available in this analysis. 5 In addition, we know that during offpump cases aortic manipulation increases the risk of stroke, as does presence of cerebrovascular disease but both these important datapoints are missing. 17 18 Finally, there are different strategies surgeons employ in scheduling multiple cases that could lead to nonrandom biases.…”

Section: Technical Complexity Versus Biasmentioning

confidence: 99%

“…Although outside the scope of this editorial, conversions have been extensively studied in off-pump CABG and can shed important light on operative risk, technical complexity and surgeon decision-making 16. The risk factors for conversions and incomplete revascularisation are similar and focus on patient anatomy, which is not available in this analysis 5. In addition, we know that during off-pump cases aortic manipulation increases the risk of stroke, as does presence of cerebrovascular disease but both these important datapoints are missing 17 18.…”

Section: Technical Complexity Versus Biasmentioning

confidence: 99%

“…3 4 With this background, Zhang and colleagues evaluate the association between procedure order (first vs nonfirst case) for each surgeon and complications following coronary artery bypass grafting (CABG). 5 The authors hypothesise that prior workload (a prior surgical procedure in the same day) would lead to more errors and complications, particularly for higher hazard procedures such as off-pump CABG. They performed a retrospective analysis of 21 866 patients in China who underwent CABG (between 08:00 and 19:00), stratifying into offpump and on-pump CABGs.…”

mentioning

confidence: 99%

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Surgeons and systems working together to drive safety and quality

Hawkins

Nallamothu

2022

BMJ Qual Saf

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Section: Surgeon Versus System Errorsmentioning

confidence: 93%

Section: Surgeon Versus System Errorsmentioning

confidence: 99%

Section: Technical Complexity Versus Biasmentioning

confidence: 99%

Section: Technical Complexity Versus Biasmentioning

confidence: 99%

mentioning

confidence: 99%

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Surgeons and systems working together to drive safety and quality

Hawkins

Nallamothu

2022

BMJ Qual Saf

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Does an aptitude for surgery exist and can we predict it? An experimental study

Ruchay,

Pape,

Cordt

et al. 2024

International Journal of Surgery

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Background: The selection and allocation of surgeons with a greater potential for high surgical performance are essential aspects of improving the quality, safety and effectiveness of surgical procedures. Objective of this trial was to determine the existence of basic skills and traits that would predict better performance in surgery, and those predictive factors that constitute a driving force in different stages of training. Materials and methods: The randomized crossover training trial took place from January 2021 to December 2021 and was conducted at an educational training center for minimally invasive surgery. A total of n=87 physicians (residents and experts) from surgical disciplines and n=239 fifth-year medical students were studied. The participants underwent extensive neuropsychological testing and surgical training, which was performed with conventional as well as robot-assisted laparoscopy by way of identical brief tasks conducted six times in a randomized crossover setting. Main Outcome was the latent factor structure of “psychomotor skills”, “personality” and “motivation” based on structural equation modeling. Results: The training performance of both students and physicians was significantly explained by the interaction of the three factors (explained variance: 8.2% for students, 23.8% for physicians). In students, motivation (explained variance 8.4%) and personality (explained variance 4.5%) revealed the highest contribution to surgical training performance (explained variance through psychomotor skills 1.1%). In physicians, psychomotor skills (explained variance 27.4%) made the greatest contribution to surgical training performance (explained variance through motivation 2.3%; explained variance through personality 10.5%). Conclusion: The study showed that surgical performance is sensitive to, and fragile in regard of non-surgery-related general individual traits. This aligns with the notion that early selection of surgeons with prospects of high surgical performance is possible, and perhaps even necessary in order to keep up with future demands on the medical system.

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Risk Prediction Models for Renal Function Decline After Cardiac Surgery Within Different Preoperative Glomerular Filtration Rate Strata

Wang,

Gao,

et al. 2024

JAHA

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Background Our goal was to create a simple risk‐prediction model for renal function decline after cardiac surgery to help focus renal follow‐up efforts on patients most likely to benefit. Methods and Results This single‐center retrospective cohort study enrolled 24 904 patients who underwent cardiac surgery from 2012 to 2019 at Fuwai Hospital, Beijing, China. An estimated glomerular filtration rate (eGFR) reduction of ≥30% 3 months after surgery was considered evidence of renal function decline. Relative to patients with eGFR 60 to 89 mL/min per 1.73 m 2 (4.5% [531/11733]), those with eGFR ≥90 mL/min per 1.73 m 2 (10.9% [1200/11042]) had a higher risk of renal function decline, whereas those with eGFR ≤59 mL/min per 1.73 m 2 (5.8% [124/2129]) did not. Each eGFR stratum had a different strongest contributor to renal function decline: increased baseline eGFR levels for patients with eGFR ≥90 mL/min per 1.73 m 2 , transfusion of any blood type for patients with eGFR 60 to 89 mL/min per 1.73 m 2 , and no recovery of renal function at discharge for patients with eGFR ≤59 mL/min per 1.73 m 2 . Different nomograms were established for the different eGFR strata, which yielded a corrected C‐index value of 0.752 for eGFR ≥90 mL/min per 1.73 m 2 , 0.725 for eGFR 60–89 mL/min per 1.73 m 2 and 0.791 for eGFR ≤59 mL/min per 1.73 m 2 . Conclusions Predictors of renal function decline over the follow‐up showed marked differences across the eGFR strata. The nomograms incorporated a small number of variables that are readily available in the routine cardiac surgical setting and can be used to predict renal function decline in patients stratified by baseline eGFR.

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Outcome differences between surgeons performing first and subsequent coronary artery bypass grafting procedures in a day: a retrospective comparative cohort study

Cited by 5 publications

References 35 publications

Surgeons and systems working together to drive safety and quality

Surgeons and systems working together to drive safety and quality

Does an aptitude for surgery exist and can we predict it? An experimental study

Risk Prediction Models for Renal Function Decline After Cardiac Surgery Within Different Preoperative Glomerular Filtration Rate Strata

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