Sarah E Deery1, Thomas F X O'Donnell1, Sara L Zettervall2, Jeremy D Darling3, Katie E Shean4, A James O'Malley5, Bruce E Landon6, Marc L Schermerhorn7. 1. Department of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Centre, Boston, MA, USA; Department of Surgery, Massachusetts General Hospital, Boston, MA, USA. 2. Department of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Centre, Boston, MA, USA; Department of Surgery, George Washington University, Washington, DC, USA. 3. Department of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Centre, Boston, MA, USA. 4. Department of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Centre, Boston, MA, USA; Department of Surgery, St. Elizabeth's Medical Centre, Boston, MA, USA. 5. Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA. 6. Department of Medicine, Beth Israel Deaconess Medical Centre, Boston, MA, USA; Department of Health Care Policy, Harvard Medical School, Boston, MA, USA. 7. Department of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Centre, Boston, MA, USA. Electronic address: mscherm@bidmc.harvard.edu.
Abstract
OBJECTIVE/ BACKGROUND: While higher lead surgeon volume has been associated with lower mortality following open abdominal aortic aneurysm (AAA) repair, little is known about the impact of using an attending surgeon as assistant surgeon. The aim of this study was to determine whether the presence of an assistant surgeon, particularly a high volume assistant, mitigates the relationship between lead surgeon volume and outcomes. METHODS: All Medicare beneficiaries who underwent intact, open AAA repair between 2003 and 2008 were evaluated and nested regression models were constructed to evaluate the relationship between surgeon and assistant volume and peri-operative mortality, adjusting for comorbid conditions and hospital volume. RESULTS: In total 28,590 repairs were studied, of which 19,284 (67.5%) were performed by a single surgeon and 9306 (32.5%) included an assistant surgeon. Of cases with an assistant, 12.3% included a high volume assistant surgeon. Lower volume surgeons more frequently used an assistant (lead surgeon Q1 volume: 40%; Q2: 36%; Q3: 34%; Q4: 29%; Q5: 27% [p < .01]). In cases with no assistant, adjusted peri-operative mortality varied monotonically with surgeon volume (Q1: 4.7%; Q2: 4.4%; Q3: 4.1%; Q4: 3.3%; Q5: 3.2%). However, the use of a high or a low volume assistant surgeon, compared with no attending surgeon as assistant, was not associated with lower peri-operative mortality in any lead surgeon volume quintile, even among those operations performed by the lowest volume lead surgeons. CONCLUSION: Employing an assistant surgeon does not improve outcomes amongst any quintile of volume of the lead surgeon. As surgeons perform fewer open AAA repairs in the modern era, these data imply that even the help of a high volume assistant surgeon may not mitigate the detrimental effect of a lower volume surgeon.
OBJECTIVE/ BACKGROUND: While higher lead surgeon volume has been associated with lower mortality following open abdominal aortic aneurysm (AAA) repair, little is known about the impact of using an attending surgeon as assistant surgeon. The aim of this study was to determine whether the presence of an assistant surgeon, particularly a high volume assistant, mitigates the relationship between lead surgeon volume and outcomes. METHODS: All Medicare beneficiaries who underwent intact, open AAA repair between 2003 and 2008 were evaluated and nested regression models were constructed to evaluate the relationship between surgeon and assistant volume and peri-operative mortality, adjusting for comorbid conditions and hospital volume. RESULTS: In total 28,590 repairs were studied, of which 19,284 (67.5%) were performed by a single surgeon and 9306 (32.5%) included an assistant surgeon. Of cases with an assistant, 12.3% included a high volume assistant surgeon. Lower volume surgeons more frequently used an assistant (lead surgeon Q1 volume: 40%; Q2: 36%; Q3: 34%; Q4: 29%; Q5: 27% [p < .01]). In cases with no assistant, adjusted peri-operative mortality varied monotonically with surgeon volume (Q1: 4.7%; Q2: 4.4%; Q3: 4.1%; Q4: 3.3%; Q5: 3.2%). However, the use of a high or a low volume assistant surgeon, compared with no attending surgeon as assistant, was not associated with lower peri-operative mortality in any lead surgeon volume quintile, even among those operations performed by the lowest volume lead surgeons. CONCLUSION: Employing an assistant surgeon does not improve outcomes amongst any quintile of volume of the lead surgeon. As surgeons perform fewer open AAA repairs in the modern era, these data imply that even the help of a high volume assistant surgeon may not mitigate the detrimental effect of a lower volume surgeon.
Authors: Sarah E Deery; Peter A Soden; Sara L Zettervall; Katie E Shean; Thomas C F Bodewes; Alexander B Pothof; Ruby C Lo; Marc L Schermerhorn Journal: J Vasc Surg Date: 2016-12-13 Impact factor: 4.268
Authors: Sara L Zettervall; Marc L Schermerhorn; Peter A Soden; John C McCallum; Katie E Shean; Sarah E Deery; A James O'Malley; Bruce Landon Journal: J Vasc Surg Date: 2016-12-14 Impact factor: 4.268
Authors: Bruce E Landon; A James O'Malley; Kristina Giles; Philip Cotterill; Marc L Schermerhorn Journal: Circulation Date: 2010-09-13 Impact factor: 29.690
Authors: N E Marlow; B Barraclough; N A Collier; I C Dickinson; J Fawcett; J C Graham; G J Maddern Journal: Eur J Vasc Endovasc Surg Date: 2010-08-05 Impact factor: 7.069
Authors: Marc L Schermerhorn; A James O'Malley; Ami Jhaveri; Philip Cotterill; Frank Pomposelli; Bruce E Landon Journal: N Engl J Med Date: 2008-01-31 Impact factor: 91.245