Mortality and Severe Complications Among Newly Graduated Surgeons in the United States

Author:

Howard Ryan A.123,Thelen Angela E.123,Chen Xilin3,Gates Rebecca3,Krumm Andrew E.134,Millis M Andrew12,Gupta Tanvi3,Brown Craig S.12,Bandeh-Ahmadi Hoda13,Wnuk Greg M.13,Yee Chia Chye3,Ryan Andrew M.56,Mukherjee Bhramar5,Dimick Justin B.12,George Brian C.1234

Affiliation:

1. Department of Surgery, University of Michigan, Ann Arbor, Michigan

2. Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan

3. Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan

4. Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan American Board of Surgery, Philadelphia, Pennsylvania

5. Department of Biostatistics and Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan

6. Center for Evaluating Health Reform, University of Michigan, Ann Arbor, Michigan

Abstract

Objective: To evaluate severe complications and mortality over years of independent practice among general surgeons. Summary Background Data: 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. Methods: 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. Results: 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 to 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 relative risk of severe complications was higher among surgeons in their first year of practice compared to surgeons in their 15th year of practice (7.5% [95% CI 6.6%-8.5%]) vs. 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 relative risk of mortality and all 26 operations had a significantly higher relative risk of severe complications in the first compared to the 15th year of practice. Conclusions: Among general surgeons performing common operations, rates of mortality and severe complications were higher among newly graduated surgeons compared to later career surgeons.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Surgery

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