Association among Surgeon Experience, Patient Risk, and Outcomes in Coronary Artery Bypass Grafting

ABSTRACT Background There is an association between surgeon experience and outcomes following cardiac surgery. However, this association is not well studied in the context of patient risk. The purpose of this single-center, retrospective, observational study was to describe how surgeon experience relates to patient risk in isolated coronary artery bypass graft (CABG) surgery and how this impacts patient outcomes. Methods Surgeon experience was defined as time between the surgeon finishing fellowship and date of the patient’s surgery. Society of Thoracic Surgeons (STS) predicted risk of mortality (PROM) was used to define patient risk. The Kaplan-Meier method was used to calculate long-term survival, and multivariable cox proportional hazards regression was used to determine the effect of surgeon experience on survival. Results Between 2002-2018, 7,652 patients underwent isolated CABG. STS PROM was 1.35% [0.70%-2.80%], 1.55% [0.79%-3.34%], 1.78% [0.84%-3.84%], and 1.19% [0.62%-2.41%] in surgeon experience quartiles 1 [0.01-6.05 years], 2 (6.05-11.5 years], 3 (11.5-16.6 years], and 4 (16.6-32.1 years] respectively (p Conclusions Increasing surgeon experience is associated with higher-risk patients, but the most experienced surgeons take on lower-risk patients. Greater experience correlates with improved outcomes, especially with higher-risk cases.