Racial Differences in Complication Risk Following Emergency General Surgery: Who Your Surgeon Is May Matter

Udyavar, N. Rhea; Salim, Ali; Cornwell, Edward E.; Hashmi, Zain G.; Lipsitz, Stuart R.; Havens, Joaquim M.; Haider, Adil H.

doi:10.1016/j.jss.2018.05.086

Cited by 5 publications

(1 citation statement)

References 32 publications

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“…Of the 55 studies, three were randomized controlled trials, 37 , 80 , 93 and 52 were observational cohort studies. The studies included various surgical specialties or aggregates thereof, including 8 or more specialties, 81 , 91 breast surgery, 59 , 73 , 74 , 101 cardiac surgery, 44 , 45 , 52 , 53 , 56 , 65–67 , 70 , 89 , 90 , 99 , 100 colorectal surgery, 34 , 61 , 68 , 71 , 78 , 85 , 92 , 103 , 104 ENT surgery, 75 gastrointestinal surgery, 34 , 83 general surgery, 34 , 37 , 57 , 77 , 79 , 82 , 86 , 93 , 95 , 96 , 102 obstetrics, 80 ophthalmology, 97 orthopedic surgery, 55 , 76 , 84 , 102 rectal surgery, 72 , 98 spinal surgery, 58 trauma surgery, 87 and urology. 62–64 , 69 , 88 , 94 , 102 38 studies were conducted in the USA, 10 in the UK, two in Austria and Sweden, one each in Canada, France, and Germany.…”

Section: Resultsmentioning

confidence: 99%

Is There a Surgeons’ Effect on Patients’ Physical Health, Beyond the Intervention, That Requires Further Investigation? A Systematic Review

Schnelle¹,

Clark²,

Mascord³

et al. 2022

TCRM

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Objective To find and review published papers researching surgeons’ effects on patients’ physical health. Clinical outcomes of surgery patients with similar prognoses cannot be fully explained by surgeon skill or experience. Just as there are “hospital” and “psychotherapist” effects, there may be “surgeons” effects that persist after controlling for known variables like patient health and operation riskiness. Methods Cohort studies and randomized controlled trials (RCTs) of any surgical intervention, which, after multivariate adjustment, either showed proportion of variance in patients’ physical health outcomes due to surgeons (random effects) or graded surgeons from best to worst (fixed effects). Studies with <15 surgeons or only ascribing surgeons’ effects to known variables excluded. Medline, PubMed, Embase, and PsycINFO were used for search until June 2020. Manual search for papers referring/referred by resulting studies. Risk of bias assessed by Cochrane risk-of-bias tool and Newcastle–Ottawa Scale. Results Included studies: 52 cohort studies and three RCTs of 52,436+ surgeons covering 102 outcomes (33 unique). Studies either graded surgeons from best to worst or calculated the intra-class correlation coefficient (ICC), the percentage of patients’ variation due to surgeons, in diverse ways. Sixteen studies showed exceptionally good and/or bad performers with confidence intervals wholly above or below the average performance. ICCs ranged from 0 to 47%, median 4.0%. There are no well-established reporting standards; highly heterogeneous reporting, therefore no meta-analysis. Discussion Interpretation: There is a surgeons' effect on patients’ physical health for many types of surgeries and outcomes, ranging from small to substantial. Surgeons with exceptional patient outcomes appear regularly even after accounting for all known confounding variables. Many existing cohort studies and RCTs could be reanalyzed for surgeons’ effects especially after methodological reporting guidelines are published. Conclusion In terms of patient outcomes, it can matter which surgeon is chosen. Surgeons with exceptional patient outcomes are worth studying further.

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