Department of Cardiovascular Surgery, University Heart Centre Freiburg University, Freiburg, Germany.
University of Freiburg, Faculty of Medicine, Freiburg, Germany.
Eur J Cardiothorac Surg. 2022 Aug 3;62(3). doi: 10.1093/ejcts/ezac171.
The aim of this study was to analyse the influence of varying experiences within each surgical team to identify team-related risk factors on clinical outcomes after total aortic arch replacement.
Each surgeon was rated from 1 to 5, and a surgical team's score was calculated (operating surgeon + assisting surgeon = team score) by relying on each member's experience. A composite end point (mortality, stroke or spinal cord injury) was defined.
Total aortic arch replacement was performed in 264 patients by 19 cardiovascular surgeons. Analysis revealed that the composite end point was attained more frequently when the team score was <7 (n = 23; 29%) than >7 (n = 35; 19%) (P = 0.015). There was a significant difference depending on the surgeon's experience [3 = 23 (35%); 4 = 9 (22%); 5 = 26 (17%); P = 0.008] and whether he was equally experienced (n = 9, 45%) or not as the assisting surgeon (n = 49, 20%; P = 0.015). Logistic regression revealed age >70 years [OR 2.93 (1.52-5.66); P = 0.001], previous stroke [OR 3.02 (1.36-6.70); P = 0.007], acute type A aortic dissection [OR 2.58 (1.08-6.13); P = 0.033], previous acute kidney injury [OR 2.27 (1.01-5.14); P = 0.049] and 2 surgeons with the same experience [OR 4.01 (1.47-10.96); P = 0.007] as predictors for the composite end point.
Total aortic arch replacement is equally safe whether an experienced surgeon carries it out or assists the procedure. A less experienced team may raise the risk for postoperative complications. Our data suggest an association of equally experienced surgeons in a team with worse outcomes than teams possessing different experience levels.
本研究旨在分析每个外科手术团队中不同经验的影响，以确定与团队相关的风险因素对全主动脉弓置换术后临床结果的影响。
每位外科医生的评分从 1 到 5 分不等，通过依赖每个成员的经验来计算手术团队的评分（主刀医生+助手医生=团队评分）。定义了一个复合终点（死亡率、中风或脊髓损伤）。
19 名心血管外科医生对 264 名患者进行了全主动脉弓置换术。分析显示，当团队得分为<7 分时（n=23；29%）比>7 分时（n=35；19%）更频繁地达到复合终点（P=0.015）。手术医生的经验存在显著差异[3 分=23（35%）；4 分=9（22%）；5 分=26（17%）；P=0.008]，以及他是否与助手医生同等经验（n=9，45%）或不同经验（n=49，20%）有关（P=0.015）。逻辑回归显示，年龄>70 岁[OR 2.93（1.52-5.66）；P=0.001]、既往中风[OR 3.02（1.36-6.70）；P=0.007]、急性A型主动脉夹层[OR 2.58（1.08-6.13）；P=0.033]、既往急性肾损伤[OR 2.27（1.01-5.14）；P=0.049]和 2 名具有相同经验的外科医生[OR 4.01（1.47-10.96）；P=0.007]是复合终点的预测因素。
无论经验丰富的外科医生主刀还是协助手术，全主动脉弓置换术都是安全的。经验较少的团队可能会增加术后并发症的风险。我们的数据表明，团队中具有相同经验的外科医生之间的关联比具有不同经验水平的团队的结果更差。
