Howard Ryan A, Thelen Angela E, Chen Xilin, Gates Rebecca, Krumm Andrew E, Millis Michael Andrew, Gupta Tanvi, Brown Craig S, Bandeh-Ahmadi Hoda, Wnuk Greg M, Yee Chia Chye, Ryan Andrew M, Mukherjee Bhramar, Dimick Justin B, George Brian C
Department of Surgery, University of Michigan, Ann Arbor, MI.
Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI.
Ann Surg. 2024 Apr 1;279(4):555-560. doi: 10.1097/SLA.0000000000006128. Epub 2023 Oct 13.
To evaluate severe complications and mortality over years of independent practice among general surgeons.
Despite concerns that newly graduated general surgeons may be unprepared for independent practice, it is unclear whether patient outcomes differ between early and later career surgeons.
We used Medicare claims for patients discharged between July 1, 2007 and December 31, 2019 to evaluate 30-day severe complications and mortality for 26 operations defined as core procedures by the American Board of Surgery. Generalized additive mixed models were used to assess the association between surgeon years in practice and 30-day outcomes while adjusting for differences in patient, hospital, and surgeon characteristics.
The cohort included 1,329,358 operations performed by 14,399 surgeons. In generalized mixed models, the relative risk (RR) of mortality was higher among surgeons in their first year of practice compared with surgeons in their 15th year of practice [5.5% (95% CI: 4.1%-7.3%) vs 4.7% (95% CI: 3.5%-6.3%), RR: 1.17 (95% CI: 1.11-1.22)]. Similarly, the RR of severe complications was higher among surgeons in their first year of practice compared with surgeons in their 15th year of practice [7.5% (95% CI: 6.6%-8.5%) versus 6.9% (95% CI: 6.1%-7.9%), RR: 1.08 (95% CI: 1.03-1.14)]. When stratified by individual operation, 21 operations had a significantly higher RR of mortality and all 26 operations had a significantly higher RR of severe complications in the first compared with the 15th year of practice.
Among general surgeons performing common operations, rates of mortality and severe complications were higher among newly graduated surgeons compared with later career surgeons.
评估普通外科医生多年独立执业期间的严重并发症和死亡率。
尽管有人担心新毕业的普通外科医生可能未做好独立执业的准备，但尚不清楚早期和后期职业生涯的外科医生的患者结局是否存在差异。
我们使用了2007年7月1日至2019年12月31日期间出院患者的医疗保险理赔数据，以评估美国外科委员会定义为核心手术的26种手术的30天严重并发症和死亡率。使用广义相加混合模型评估外科医生执业年限与30天结局之间的关联，同时调整患者、医院和外科医生特征的差异。
该队列包括14399名外科医生实施的1329358例手术。在广义混合模型中，与执业第15年的外科医生相比，执业第一年的外科医生的死亡率相对风险（RR）更高[5.5%（95%CI：4.1%-7.3%）对4.7%（95%CI：3.5%-6.3%），RR：1.17（95%CI：1.11-1.22）]。同样，与执业第15年的外科医生相比，执业第一年的外科医生的严重并发症RR更高[7.5%（95%CI：6.6%-8.5%）对6.9%（95%CI：6.1%-7.9%），RR：1.08（95%CI：1.03-1.14）]。按个体手术分层时，与执业第15年相比，21种手术的死亡率RR显著更高，所有26种手术的严重并发症RR在第一年也显著更高。
在进行常见手术的普通外科医生中，新毕业的外科医生的死亡率和严重并发症发生率高于后期职业生涯的外科医生。
