• Ryan A Howard, Angela E Thelen, Xilin Chen, Rebecca Gates, Andrew E Krumm, Michael Andrew Millis, Tanvi Gupta, Craig S Brown, Hoda Bandeh-Ahmadi, Greg M Wnuk, Chia Chye Yee, Andrew M Ryan, Bhramar Mukherjee, Justin B Dimick, and Brian C George.
• Department of Surgery, University of Michigan, Ann Arbor, MI.
• Ann. Surg. 2024 Apr 1; 279 (4): 555560555-560.

ObjectiveTo evaluate severe complications and mortality over years of independent practice among general surgeons.BackgroundDespite 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.MethodsWe 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.ResultsThe 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.ConclusionsAmong general surgeons performing common operations, rates of mortality and severe complications were higher among newly graduated surgeons compared with later career surgeons.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

19 keywords...

hide…