Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan.
Department of Surgery, University of Michigan, Ann Arbor, Michigan.
Ann Surg. 2021 Aug 1;274(2):220-226. doi: 10.1097/SLA.0000000000004709.
To determine if initial American Board of Surgery certification in general surgery is associated with better risk-adjusted patient outcomes for Medicare patients undergoing partial colectomy by an early career surgeon.
Board certification is a voluntary commitment to professionalism, continued learning, and delivery of high-quality patient care. Not all surgeons are certified, and some have questioned the value of certification due to limited evidence that board-certified surgeons have better patient outcomes. In response, we examined the outcomes of certified versus noncertified early career general surgeons.
We identified Medicare patients who underwent a partial colectomy between 2008 and 2016 and were operated on by a non-subspecialty trained surgeon within their first 5 years of practice. Surgeon certification status was determined using the American Board of Surgery data. Generalized linear mixed models were used to control for patient-, procedure-, and hospital-level effects. Primary outcomes were the occurrence of severe complications and occurrence of death within 30 days.
We identified 69,325 patients who underwent a partial colectomy by an early career general surgeon. The adjusted rate of severe complications after partial colectomy by certified (n = 4239) versus noncertified (n = 191) early-career general surgeons was 9.1% versus 10.7% (odds ratio 0.83, P = 0.03). Adjusted mortality rate for certified versus noncertified early-career general surgeons was 4.9% versus 6.1% (odds ratio 0.79, P = 0.01).
Patients undergoing partial colectomy by an early career general surgeon have decreased odds of severe complications and death when their surgeon is board certified.
确定早期职业外科医生对接受部分结肠切除术的 Medicare 患者进行初次美国外科委员会普通外科认证是否与更好的风险调整患者结局相关。
委员会认证是对专业精神、持续学习和提供高质量患者护理的自愿承诺。并非所有外科医生都获得认证，由于没有有限的证据表明认证外科医生的患者结局更好，一些人对认证的价值提出了质疑。作为回应，我们检查了认证和非认证的早期职业普通外科医生的结果。
我们确定了 2008 年至 2016 年间接受部分结肠切除术且在执业的前 5 年内由非专科培训外科医生进行手术的 Medicare 患者。使用美国外科委员会数据确定外科医生认证状态。使用广义线性混合模型控制患者、手术和医院层面的影响。主要结局是 30 天内发生严重并发症和死亡的发生。
我们确定了 69325 名由早期职业普通外科医生进行部分结肠切除术的患者。经过认证（n = 4239）与未经认证（n = 191）的早期职业普通外科医生进行部分结肠切除术的严重并发症调整发生率分别为 9.1%和 10.7%（比值比 0.83，P = 0.03）。认证与非认证的早期职业普通外科医生的调整死亡率分别为 4.9%和 6.1%（比值比 0.79，P = 0.01）。
当患者的外科医生获得认证时，接受早期职业普通外科医生进行部分结肠切除术的患者发生严重并发症和死亡的几率降低。
