Details

Autor(en) / Beteiligte

• Burt, Bryan M., MD
• ElBardissi, Andrew W., MD, MPH
• Huckman, Robert S., PhD
• Cohn, Lawrence H., MD
• Cevasco, Marisa W., MD
• Rawn, James D., MD
• Aranki, Sary F., MD
• Byrne, John G., MD

Titel

Influence of experience and the surgical learning curve on long-term patient outcomes in cardiac surgery

Ist Teil von

• The Journal of thoracic and cardiovascular surgery, 2015-11, Vol.150 (5), p.1061-1068.e3

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2015

Quelle

MEDLINE

Beschreibungen/Notizen

• Abstract Objective We hypothesized that increased postgraduate surgical experience correlates with improved operative efficiency and long-term survival in standard cardiac surgery procedures. Methods Utilizing a prospectively collected retrospective database, we identified patients who underwent isolated coronary artery bypass grafting (CABG) (n = 3726), aortic valve replacement (AVR) (n = 1626), mitral valve repair (n = 731), mitral valve replacement (MVR) (n = 324), and MVR + AVR (n = 184) from January 2002 through June 2012. After adjusting for patient risk and surgeon variability, we evaluated the influence of surgeon experience on cardiopulmonary bypass and crossclamp times, and long-term survival. Results Mean surgeon experience after fellowship graduation was 16.0 ± 11.7 years (range, 1.0-35.2 years). After adjusting for patient risk and surgeon-level fixed effects, learning curve analyses demonstrated improvements in cardiopulmonary bypass and crossclamp times with increased surgeon experience. There was marginal improvement in the predictability ( R2 value) of cardiopulmonary bypass and crossclamp time for CABG with the addition of surgeon experience; however, all other procedures had marked increases in the R2 following addition of surgeon experience. Cox proportional hazard models revealed that increased surgeon experience was associated with improved long-term survival in AVR (hazard ratio [HR], 0.85; P  < .0001), mitral valve repair (HR, 0.73; P  < .0001), and MVR + AVR (HR, 0.95; P  = .006) but not in CABG (HR, 0.80; P  = .15), and a trend toward significance in MVR (HR, 0.87; P  = .09). Conclusions In cardiac surgery, not including CABG, surgeon experience is an important determinant of operative efficiency and of long-term survival.