Deaths no higher in patients of new surgeons

Main Category: Public Health
Article Date: 06 Aug 2004 - 11:00 PDT

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Patients and hospitals should be reassured that being operated on by newly appointed heart surgeons carries a similar risk of death as being operated on by established surgeons, say researchers in a study available on bmj.com.

However, they did find a progressive fall in deaths in the first four years after appointment, suggesting that there is still a learning curve associated with moving from surgical training to independent practice.

The study involved over 18,000 patients undergoing coronary artery surgery for the first time between 1997 and 2003. Observed and predicted death rates for surgeons in the first four years after their consultant appointment were compared with figures for more established surgeons.

A total of 374 (2%) of patients undergoing surgery during the study died. Overall, death rates among patients of surgeons in the first four years after appointment were not significantly higher than those of more established consultants.

However, observed deaths did fall as surgeons became more experienced - from 2.2% in the first year to 1.2% in the fourth year. This result did not change after accounting for time and case mix. In contrast, predicted deaths increased in the four years after appointment, suggesting that surgeons are operating on patients with more complex illnesses.

This study suggests that patients and hospitals can be reassured that death is not higher in patients of newly appointed surgeons, say the authors.

However, plans to shorten the surgical training period, along with a reduction in training hours due to implementation of the European working time directive, may have implications on the experience of new consultants in the future, which may increase possible learning curve effects unless other modifying influences are introduced.

Planned publication of surgeon specific mortality and use of performance data in clinical excellence awards may well influence learning curves in future but may also encourage newly appointed surgeons to turn down higher risk cases, unless robust risk adjusted measures are used, they warn.

Contact:

Ben Bridgewater, Consultant Cardiac Surgeon, South Manchester University Hospital, Manchester, UK Email: ben.bridgewater@smuht.nwest.nhs.uk

(Improving mortality of coronary surgery over first four years of independent practice: retrospective examination of prospectively collected data from 15 surgeons)
http://bmj.bmjjournals.com/cgi/reprint/bmj.38173.577697.55

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