Surgeon characteristics associated with mortality and morbidity following carotid endarterectomy

O’Neill, Liam; Lanska, Douglas J.; Hartz, Arthur J.

doi:10.1212/wnl.55.6.773

Cited by 130 publications

(93 citation statements)

References 54 publications

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“…A progressive improvement of scores from resident to fellows to practicing surgeons supports the evidence that judgment improves through training, peaks shortly after training, and then begins to plateau or decline. This has been shown in several studies by demonstrating an increase in mortality of patients undergoing cardiac procedures with increasing years of practice of the primary surgeon (Hartz et al 1999;O'Neill et al 2000). Similar findings of increased mortality is also seen in a study of outcomes of acute myocardial infarction that showed an increase of 0.5% mortality for every year since the physician graduated from medical school (Norcini et al 2000).…”

Section: Discussionsupporting

confidence: 54%

Assessing intraoperative judgment using script concordance testing through the gynecology continuum of practice

et al. 2014

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Objective: To measure surgical judgment across the Obstetrics and Gynecology (OBGYN) continuum of practice and identify factors that correlate with improved surgical judgment. Methods: A 45-item written examination was developed using script concordance theory, which compares an examinee's responses to a series of ''ill-defined'' surgical scenarios to a reference panel of experts. The examination was administered to OBGYN residents, Female Pelvic Medicine and Reconstructive Surgery (FPMRS) fellows, practicing OBGYN physicians and FPMRS experts. Surgical judgment was evaluated by comparing scores against the experts. Factors related to surgical experience were measured for association with scores. Results: In total, 147 participants including 11 residents, 37 fellows, 88 practicing physicians and 11 experts completed the 45-item examination. Mean scores for practicing physicians (65.2 AE 7.4) were similar to residents (67.2 AE 7.1), and worse than fellows (72.6 AE 4.2, p50.

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Section: Discussionsupporting

confidence: 54%

Assessing intraoperative judgment using script concordance testing through the gynecology continuum of practice

et al. 2014

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“…10 For studies specifically of surgical performance, there are also other reports showing that more years of experience are associated with worse patient outcomes following carotid endarterectomy, coronary artery bypass surgery, and pancreatectomy. [4][5][6] In contrast, one study reported that worse outcomes were observed for patients of young surgeons undergoing high-complexity alimentary tract surgery. 7 Although our study did not address the potential mechanisms responsible for the relationship between surgeon age and operative outcomes of primary RRD surgery, several possibilities might explain this effect.…”

Section: Resultsmentioning

confidence: 99%

“…4 Other studies also showed that more years of experience were associated with worse patient outcomes following carotid endarterectomy and coronary artery bypass surgery. 5,6 On the other hand, it is generally assumed that the knowledge, skills, and experience accumulated by physicians during years of practice may result in better clinical capabilities. 2 One report also suggested that surgeon youth and inexperience were more important risk factors for surgical mortality.…”

Section: Introductionmentioning

confidence: 99%

Surgeon age and operative outcomes for primary rhegmatogenous retinal detachment: a 3-year nationwide population-based study

Kuo

Tsai³

et al. 2009

Eye

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Purpose The aim was to study the association of surgeon age with operative outcomes for primary rhegmatogenous retinal detachment (RRD) in Taiwan. Methods A total of 7427 adult patients of primary RRD who were treated by 284 ophthalmologists with scleral buckling (SB), pars plana vitrectomy (PPV), or their combination from 2002 to 2004 were identified in the Taiwan National Health Insurance Research Database. The adjusted odds ratios (OR) of 180-day readmission between ophthalmologist age groups were calculated. Results For SB, patients treated by ophthalmologists aged X51 years had a greater 180-day readmission rate (OR ¼ 1.44, 95% confidence interval (CI) ¼ 1.01-2.07, Po0.05) than those treated by ophthalmologists aged 41-50 years. For PPV, patients treated by ophthalmologists aged p40 years had a lower 180-day readmission rate than those treated by ophthalmologists aged 41-50 and X51 years (OR ¼ 0.58 and 0.22, 95% CI ¼ 0.47-0.71 and 0.13-0.63, Po0.001 and o0.001, respectively). For PPV þ SB, patients treated by ophthalmologists aged X51 years had a higher 180-day readmission rate than those treated by ophthalmologists aged p40 and 41-50 years (OR ¼ 3.32 and 2.45, 95% CI ¼ 2.29-4.21 and 1.36-4.40, Po0.01 and o0.01, respectively). The absolute differences in the 180-day readmission rate by surgeon age ranged from À0.1 to 3.2%. The proportions of selecting primary SB (without PPV) as the treatment modality were 33.1, 35.6, and 70.6% for the p40-, 41-to 50-, and X51-year groups, respectively. Conclusions Surgeon age is a relatively weak predictor for the outcomes of primary RRD surgery in aggregate in Taiwan and certainly not appropriate for discriminating performance among individual surgeons.

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“…O'Neill et al [17] studied the relationship between years since licensure of the surgeon (and other factors) and death, or complications short of death, for the procedure of carotid endarterectomy. The study included 12,725 operations in 284 hospitals.…”

Section: Remoteness Of Educationmentioning

confidence: 99%

The Problem of the Aging Surgeon: When Surgeon Age Becomes a Surgical Risk Factor

Blasier¹

2009

Clinical Orthopaedics &Amp; Related Research

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The question of when a surgeon should retire has been the subject of debate for decades. Both anecdotal evidence and objective testing of surgeons suggest age causes deterioration in physical and cognitive performance. Medical education, residency and fellowship training, and technology evolve at a rapid pace, and the older a surgeon is, the more likely it is he or she is remote from his or her initial education in his or her specialty. Research also shows surgeons are reluctant to plan for retirement. Although there is no federally mandated retirement age for surgeons in the United States, surgeons must realize their skills will decline, a properly planned retirement can be satisfying, and the retired surgeon has much to offer the medical and teaching community.

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Surgeon characteristics associated with mortality and morbidity following carotid endarterectomy

Abstract: More years since licensure and very low patient volume are associated with worse patient outcomes following CEA.

Cited by 130 publications

References 54 publications

Assessing intraoperative judgment using script concordance testing through the gynecology continuum of practice

Assessing intraoperative judgment using script concordance testing through the gynecology continuum of practice

Surgeon age and operative outcomes for primary rhegmatogenous retinal detachment: a 3-year nationwide population-based study

The Problem of the Aging Surgeon: When Surgeon Age Becomes a Surgical Risk Factor

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