Olympia Papachristofi1, Jonathan H Mackay2, Sarah J Powell3, Samer A M Nashef4, Linda Sharples5. 1. MRC Biostatistics Unit, Institute of Public Health, Cambridge, United Kingdom. Electronic address: olympia.papachristofi@mrc-bsu.cam.ac.uk. 2. Department of Anesthesia, Papworth Hospital, Cambridge, United Kingdom. 3. Department of Clinical Audit, Papworth Hospital, Cambridge, United Kingdom. 4. Department of Surgery, Papworth Hospital, Cambridge, United Kingdom. 5. Department of Research and Development, Papworth Hospital, Cambridge, United Kingdom.
Abstract
OBJECTIVE: To determine the impact of anesthesiologists, surgeons, and their monthly caseload volume on mortality after cardiac surgery. DESIGN: Ten-year audit of prospectively collected cardiac surgical data. SETTING: Large adult cardiothoracic hospital. PARTICIPANTS: A total of 18,569 cardiac surgical patients in the decade from April 2002 through March 2012, plus 21 consultant surgeons and 29 consultant anesthesiologists. INTERVENTIONS: Major risk-stratified cardiac surgical operations. METHODS: The primary outcome was in-hospital death. Random intercept models for the surgeon and anesthesiologist cluster, respectively, were fitted, achieving risk-adjustment through the logistic EuroSCORE. The intraclass correlation coefficient (ICC) subsequently was used to measure the amount of outcome variation due to clustering. MEASUREMENTS AND MAIN RESULTS: After exclusions (duplicates, very-short-term appointments, and cases performed by more than one consultant), there were 18,426 patients with 581 (3.15%) in-hospital deaths. The overwhelming factor associated with outcome variation was the patient risk profile, accounting for 97.14% of the variation. The impact of the surgeon was small (ICC = 2.78%), and the impact of the anesthesiologist was negligible (ICC = 0.08%). Low monthly surgeon volume of surgery, adjusted for average case mix, was associated with higher risk-adjusted mortality (odds ratio = 0.93, 95% CI 0.87-0.98). CONCLUSIONS: Outcome was determined primarily by the patient. There were small but significant differences in outcome between surgeons. The attending anesthesiologist did not affect patient outcome in this institution. Low average monthly surgeon volume was a significant risk factor. In contrast, low average monthly anesthesiologist volume had no effect.
OBJECTIVE: To determine the impact of anesthesiologists, surgeons, and their monthly caseload volume on mortality after cardiac surgery. DESIGN: Ten-year audit of prospectively collected cardiac surgical data. SETTING: Large adult cardiothoracic hospital. PARTICIPANTS: A total of 18,569 cardiac surgical patients in the decade from April 2002 through March 2012, plus 21 consultant surgeons and 29 consultant anesthesiologists. INTERVENTIONS: Major risk-stratified cardiac surgical operations. METHODS: The primary outcome was in-hospital death. Random intercept models for the surgeon and anesthesiologist cluster, respectively, were fitted, achieving risk-adjustment through the logistic EuroSCORE. The intraclass correlation coefficient (ICC) subsequently was used to measure the amount of outcome variation due to clustering. MEASUREMENTS AND MAIN RESULTS: After exclusions (duplicates, very-short-term appointments, and cases performed by more than one consultant), there were 18,426 patients with 581 (3.15%) in-hospital deaths. The overwhelming factor associated with outcome variation was the patient risk profile, accounting for 97.14% of the variation. The impact of the surgeon was small (ICC = 2.78%), and the impact of the anesthesiologist was negligible (ICC = 0.08%). Low monthly surgeon volume of surgery, adjusted for average case mix, was associated with higher risk-adjusted mortality (odds ratio = 0.93, 95% CI 0.87-0.98). CONCLUSIONS: Outcome was determined primarily by the patient. There were small but significant differences in outcome between surgeons. The attending anesthesiologist did not affect patient outcome in this institution. Low average monthly surgeon volume was a significant risk factor. In contrast, low average monthly anesthesiologist volume had no effect.
Authors: Natalie S Blencowe; Julia M Brown; Jonathan A Cook; Chris Metcalfe; Dion G Morton; Jon Nicholl; Linda D Sharples; Shaun Treweek; Jane M Blazeby Journal: Trials Date: 2015-09-04 Impact factor: 2.279
Authors: Olympia Papachristofi; Andrew A Klein; John Mackay; Samer Nashef; Nick Fletcher; Linda D Sharples Journal: BMJ Open Date: 2017-09-11 Impact factor: 2.692