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A National Comparison of Operative Outcomes of New and Experienced Surgeons.
Kelz, Rachel R; Sellers, Morgan M; Niknam, Bijan A; Sharpe, James E; Rosenbaum, Paul R; Hill, Alexander S; Zhou, Hong; Hochman, Lauren L; Bilimoria, Karl Y; Itani, Kamal; Romano, Patrick S; Silber, Jeffrey H.
Afiliação
  • Kelz RR; Department of Surgery, Center for Surgery and Health Economics, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
  • Sellers MM; The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA.
  • Niknam BA; Department of Surgery, Center for Surgery and Health Economics, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
  • Sharpe JE; Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, PA.
  • Rosenbaum PR; Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, PA.
  • Hill AS; The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA.
  • Zhou H; Department of Statistics, The Wharton School, The University of Pennsylvania, Philadelphia, PA.
  • Hochman LL; Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, PA.
  • Bilimoria KY; Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, PA.
  • Itani K; Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, PA.
  • Romano PS; Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Northwestern Medicine, Chicago IL.
  • Silber JH; VA Boston Health Care System, Boston, MA.
Ann Surg ; 273(2): 280-288, 2021 02 01.
Article em En | MEDLINE | ID: mdl-31188212
OBJECTIVE: To determine whether outcomes achieved by new surgeons are attributable to inexperience or to differences in the context in which care is delivered and patient complexity. BACKGROUND: Although prior studies suggest that new surgeon outcomes are worse than those of experienced surgeons, factors that underlie these phenomena are poorly understood. METHODS: A nationwide observational tapered matching study of outcomes of Medicare patients treated by new and experienced surgeons in 1221 US hospitals (2009-2013). The primary outcome studied is 30-day mortality. Secondary outcomes were examined. RESULTS: In total, 694,165 patients treated by 8503 experienced surgeons were matched to 68,036 patients treated by 2119 new surgeons working in the same hospitals. New surgeons' patients were older (25.8% aged ≥85 vs 16.3%,P<0.0001) with more emergency admissions (53.9% vs 25.8%,P<0.0001) than experienced surgeons' patients. Patients of new surgeons had a significantly higher baseline 30-day mortality rate compared with patients of experienced surgeons (6.2% vs 4.5%,P<0.0001;OR 1.42 (1.33, 1.52)). The difference remained significant after matching the types of operations performed (6.2% vs 5.1%, P<0.0001; OR 1.24 (1.16, 1.32)) and after further matching on a combination of operation type and emergency admission status (6.2% vs 5.6%, P=0.0007; OR 1.12 (1.05, 1.19)). After matching on operation type, emergency admission status, and patient complexity, the difference between new and experienced surgeons' patients' 30-day mortality became indistinguishable (6.2% vs 5.9%,P=0.2391;OR 1.06 (0.97, 1.16)). CONCLUSIONS: Among Medicare beneficiaries, the majority of the differences in outcomes between new and experienced surgeons are related to the context in which care is delivered and patient complexity rather than new surgeon inexperience.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Complicações Pós-Operatórias / Procedimentos Cirúrgicos Operatórios / Competência Clínica Tipo de estudo: Observational_studies Limite: Aged / Female / Humans / Male País/Região como assunto: America do norte Idioma: En Revista: Ann Surg Ano de publicação: 2021 Tipo de documento: Article País de publicação: Estados Unidos
Texto completo
Adicionar na Minha BVS
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Complicações Pós-Operatórias / Procedimentos Cirúrgicos Operatórios / Competência Clínica Tipo de estudo: Observational_studies Limite: Aged / Female / Humans / Male País/Região como assunto: America do norte Idioma: En Revista: Ann Surg Ano de publicação: 2021 Tipo de documento: Article País de publicação: Estados Unidos