Impact of Surgeon Experience on Clinical Outcomes in Cardiovascular Surgery: A Retrospective Analysis

Öz

Objective: This study aimed to assess the impact of surgeons' experience (10–20 years vs. over 20 years) on clinical outcomes in coronary artery bypass grafting (CABG) surgeries, considering the multidisciplinary nature of cardiovascular surgery and the critical role of experience in influencing mortality, morbidity, and complications. Materials and Methods: A retrospective analysis was conducted, including 201 patients who underwent elective or emergency CABG between 2019 and 2024 at a single tertiary center. Patients were grouped based on the experience level of their surgeons. Demographic, intraoperative, and postoperative data were collected from hospital records. Results: Patients operated on by surgeons with over 20 years of experience had significantly higher rates of hypertension (83% vs. 70.3%; p=0.033) but showed no significant differences in mortality (3% vs. 2%; p=0.170) or complication rates (7% vs. 9.9%; p=0.460). Intraoperative parameters, such as cross-clamp time and cardiopulmonary bypass time, did not differ significantly between the groups (p>0.05). Weak positive correlations were found between cross-clamp time and postoperative ICU stay (r=0.189; p=0.007), as well as cardiopulmonary bypass time and ICU stay (r=0.205; p=0.003). Conclusions: Surgeons' experience levels influence certain clinical outcomes, particularly in managing high-risk patients. However, mortality and complication rates appear to depend more on multidisciplinary care and standardized protocols than on individual experience. Future studies should explore these dynamics across broader patient populations and different surgical procedures to optimize cardiovascular surgical practices.

Anahtar Kelimeler

• Clinical outcomes
• coronary artery bypass grafting
• cardiovascular surgery
• retrospective study
• surgeon experience

Kardiyovasküler Cerrahide Cerrah Deneyiminin Klinik Sonuçlar Üzerindeki Etkisi: Retrospektif Bir Analiz

Öz

Amaç: Bu çalışmada, kardiyovasküler cerrahinin multidisipliner doğası ve deneyimin mortalite, morbidite ve komplikasyonları etkilemedeki kritik rolü göz önünde bulundurularak, koroner arter bypass greftleme (KABG) ameliyatlarında cerrahların deneyiminin (10-20 yıl ve 20 yıldan fazla) klinik sonuçlar üzerindeki etkisinin değerlendirilmesi amaçlanmıştır. Materyal ve Metot: Tek bir üçüncü basamak merkezde 2019-2024 yılları arasında elektif veya acil KABG uygulanan 201 hastayı içeren retrospektif bir analiz yapılmıştır. Hastalar, cerrahlarının deneyim düzeyine göre gruplandırıldı. Demografik, intraoperatif ve postoperatif veriler hastane kayıtlarından toplanmıştır. Bulgular: Yirmi yıldan fazla deneyime sahip cerrahlar tarafından ameliyat edilen hastalarda hipertansiyon oranları anlamlı derecede yüksekti (%83'e karşı %70,3; p=0,033) ancak mortalite (%3'e karşı %2; p=0,170) veya komplikasyon oranlarında (%7'ye karşı %9,9; p=0,460) anlamlı bir fark yoktu. Kros-klemp süresi ve kardiyopulmoner bypass süresi gibi intraoperatif parametreler gruplar arasında anlamlı farklılık göstermemiştir (p>0,05). Kros-klemp süresi ile ameliyat sonrası YBÜ'de kalış süresi (r=0,189; p=0,007) ve kardiyopulmoner baypas süresi ile YBÜ'de kalış süresi (r=0,205; p=0,003) arasında zayıf pozitif korelasyon bulundu. Sonuç: Cerrahların deneyim düzeyleri, özellikle yüksek riskli hastaların yönetiminde belirli klinik sonuçları etkilemektedir. Bununla birlikte, mortalite ve komplikasyon oranları bireysel deneyimden ziyade multidisipliner bakım ve standartlaştırılmış protokollere bağlı görünmektedir. Gelecekteki çalışmalar, kardiyovasküler cerrahi uygulamalarını optimize etmek için bu dinamikleri daha geniş hasta popülasyonlarında ve farklı cerrahi prosedürlerde araştırmalıdır.

Anahtar Kelimeler

• Kardiyovasküler cerrahi
• klinik sonuçlar
• koroner arter baypas greftleme
• retrospektif çalışma
• cerrah deneyimi

Kaynakça

1. 1. Smoor RM, Dongen EP, Daeter EJ, et al. The association between preoperative multidisciplinary team care and patient outcome in frail patients undergoing cardiac surgery. J Thorac Cardiovasc Surg. 2024;168(2):608-616.e5. doi:10.1016/j.jtcvs.2023.05.037
2. 2. Pearce WH, Parker MA, Feinglass J, Ujiki M, Manheim LM. The importance of surgeon volume and training in outcomes for vascular surgical procedures. J Vasc Surg. 1999;29(5):768-776. doi:10.1016/s0741-5214(99)70202-8
3. 3. Stulberg JJ, Huang R, Kreutzer L, et al. Association between surgeon technical skills and patient outcomes. JAMA Surg. 2020;155(10):960-968. doi:10.1001/jamasurg.2020.3007
4. 4. Woods MS, Liberman JN, Rui P, et al. Association between surgical technical skills and clinical outcomes: a systematic literature review and meta-analysis. JSLS. 2023;27(1). doi:10.4293/jsls.2022.00076
5. 5. Hance J, Aggarwal R, Stanbridge R, et al. Objective assessment of technical skills in cardiac surgery. Eur J Cardiothorac Surg. 2005;28(1):157-162. doi:10.1016/j.ejcts.2005.03.012
6. 6. Wahr JA, Prager RL, Abernathy JH, et al. Patient safety in the cardiac operating room: human factors and teamwork: a scientific statement from the American Heart Association. Circulation. 2013;128(10):1139-1169. doi:10.1161/CIR.0b013e3182a38efa
7. 7. Riddle EW, Kewalramani D, Narayan M, Jones DB. Surgical simulation: virtual reality to artificial intelligence. Curr Probl Surg. 2024;61(11):101625. doi:10.1016/j.cpsurg.2024.101625
8. 8. Reddy K, Gharde P, Tayade H, et al. Advancements in robotic surgery: a comprehensive overview of current utilizations and upcoming frontiers. Cureus. 2023;15(12):e50415. doi:10.7759/cureus.50415

9. 9. Javed H, Olanrewaju OA, Ansah OF, et al. Challenges and solutions in postoperative complications: a narrative review in general surgery. Cureus. 2023;15(12):e50942. doi:10.7759/cureus.50942
10. 10. Cheng H, Clymer JW, Po-Han CB, et al. Prolonged operative duration is associated with complications: a systematic review and meta-analysis. J Surg Res. 2018;229:134-144. doi:10.1016/j.jss.2018.03.022
11. 11. Subramanian M, Kozower BD, Brown LM, Khullar OV, Fernandez FG. Patient-reported outcomes in cardiothoracic surgery. Ann Thorac Surg. 2019;107(1):294-301. doi:10.1016/j.athoracsur.2018.06.005
12. 12. Kim DJ, Sohn B. The impact of an attending intensivist on the clinical outcomes of patients admitted to the cardiac surgical intensive care unit after coronary artery bypass grafting. Korean J Thorac Cardiovasc Surg. 2020;53(1):8-15. doi:10.5090/kjtcs.2020.53.1.8
13. 13. Epstein NE. Multidisciplinary in-hospital teams improve patient outcomes: a review. Surg Neurol Int. 2014;5(Suppl 7):295-303. doi:10.4103/2152-7806.139612
14. 14. Marrelli M, Gentile S, Palmieri F, et al. Correlation between surgeon's experience, surgery complexity, and the alteration of stress-related physiological parameters. PLoS One. 2014;9(11):e112444. doi:10.1371/journal.pone.0112444
15. 15. Guidry CA, Newhook TE, Turrentine FE, et al. Observations on surgeons' case selection, morbidity, and mortality following board certification. Ann Surg. 2016;263(3):487-492. doi:10.1097/sla.0000000000001361
16. 16. Lien YC, Huang MT, Lin HC. Association between surgeon and hospital volume and in-hospital fatalities after lung cancer resections: the experience of an Asian country. Ann Thorac Surg. 2007;83(5):1837-1843. doi:10.1016/j.athoracsur.2006.12.008
17. 17. Salenger R, Lobdell K, Grant MC. Update on minimally invasive cardiac surgery and enhanced recovery after surgery. Curr Opin Anesthesiol. 2024;37(1):10-15. doi:10.1097/ACO.0000000000001322
18. 18. Massarweh NN, Anaya DA, Kougias P, et al. Variation and impact of multiple complications on failure to rescue after inpatient surgery. Ann Surg. 2017;266(1):59-65. doi:10.1097/sla.0000000000001917
19. 19. Liu DS, Fayed A, Evans P, et al. Understanding potentially preventable mortality following oesophago-gastric cancer surgery: analysis of a national audit of surgical mortality. Ann Surg Oncol. 2023;30(8):4950-4961. doi:10.1245/s10434-023-13571-8
20. 20. Whitten CW, Hill GE, Ivy R, Greilich PE, Lipton JM. Does the duration of cardiopulmonary bypass or aortic cross-clamp, in the absence of blood and/or blood product administration, influence the IL-6 response to cardiac surgery? Anesth Analg. 1998;86(1):28-33. doi:10.1097/00000539-199801000-00006
21. 21. Seal F, Wang S, Zheng B. Identifying the effect of the surgical team on cardiac surgery operation time: a retrospective analysis. Perioper Care Oper Room Manag. 2022;26:100226. doi:10.1016/j.pcorm.2021.100226
22. 22. Harrison EM, Drake TM, O'Neill S. Individual surgeon mortality rates: can outliers be detected? A national utility analysis. BMJ Open. 2016;6(10):e012471. doi:10.1136/bmjopen-2016-012471
23. 23. Brooks ES, Wirtalla CJ, Rosen CB, et al. Variation in hospital performance for general surgery in younger and older adults: a retrospective cohort study. Ann Surg. 2024;280(2):261-266. doi:10.1097/sla.0000000000006184
24. 24. Dener H, Elçin M. The experiences of cardiovascular surgeons and nurses with mutual support through interprofessional collaboration in the intensive care unit. Nurs Crit Care. 2024. doi:10.1111/nicc.13220