Amine Mazine1, Louis-Mathieu Stevens2, Aly Ghoneim3, Jennifer Chung4, Maral Ouzounian4, Francois Dagenais5, Ismail El-Hamamsy3, Munir Boodhwani6, John Bozinovski7, Mark D Peterson8, Michael W A Chu9. 1. Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada. 2. Division of Cardiac Surgery, Department of Surgery, Centre Hospitalier Universitaire de Montréal and Université de Montréal, Montreal, Quebec, Canada. 3. Division of Cardiac Surgery, Department of Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada. 4. Division of Cardiac Surgery, Department of Surgery, Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada. 5. Division of Cardiac Surgery, Department of Surgery, Institut universitaire de cardiologie et de pneumologie de Québec and Université Laval, Quebec City, Quebec, Canada. 6. Division of Cardiac Surgery, Department of Surgery, Ottawa Heart Institute and University of Ottawa, Ottawa, Ontario, Canada. 7. Division of Cardiac Surgery, Department of Surgery, Royal Jubilee Hospital and University of British Columbia, Victoria, British Columbia, Canada. 8. Division of Cardiac Surgery, Department of Surgery, St Michael's Hospital and University of Toronto, Toronto, Ontario, Canada. 9. Division of Cardiac Surgery, Department of Surgery, London Health Sciences Center and University of Western Ontario, London, Ontario, Canada. Electronic address: michael.chu@lhsc.on.ca.
Abstract
OBJECTIVES: To examine the performance curves of 8 early-career aortic surgeons with the use of hypothermic circulatory arrest (HCA) and to analyze the impact of the learning curve on perioperative outcomes. METHODS: A total of 1025 consecutive patients who underwent aortic reconstruction with HCA between 2002 and 2017 were analyzed for mortality and 5 other complications (stroke, reoperation for bleeding, dialysis, prolonged ventilation, and sternal wound complications), subdivided into 3 consecutive time periods. This cohort represents the complete inaugural experience of 8 Canadian academic aortic surgeons. A risk-adjusted cumulative sum analysis was used to evaluate the performance curve with respect to predetermined 80% alert and 95% alarm boundary lines. RESULTS: Mean age was 62 ± 13 years, 71% of patients were male, and 24% presented nonelectively. Hemiarch repair was performed in 80% and total arch replacement in 20%. There was a reduction in the incidence of the primary composite outcome over time (P1: 26%, P2: 23%, and P3: 16%; P = .010). Overall in-hospital mortality was 5% and remained stable throughout the 3 periods. Rates of stroke were lower in the late period (P1: 4%, P2: 6%, and P3: 2%; P = .035). Risk-adjusted cumulative sum analysis demonstrated that all surgeons remained within the 95% reassurance boundary throughout their experience, with 6 surgeons performing as expected and 2 performing better than expected. CONCLUSIONS: Early-career surgeons can safely perform operations with HCA from the initiation of their practice. The cumulative sum analysis method is valuable for monitoring competence in aortic surgery and could prove useful in structuring training programs.
OBJECTIVES: To examine the performance curves of 8 early-career aortic surgeons with the use of hypothermic circulatory arrest (HCA) and to analyze the impact of the learning curve on perioperative outcomes. METHODS: A total of 1025 consecutive patients who underwent aortic reconstruction with HCA between 2002 and 2017 were analyzed for mortality and 5 other complications (stroke, reoperation for bleeding, dialysis, prolonged ventilation, and sternal wound complications), subdivided into 3 consecutive time periods. This cohort represents the complete inaugural experience of 8 Canadian academic aortic surgeons. A risk-adjusted cumulative sum analysis was used to evaluate the performance curve with respect to predetermined 80% alert and 95% alarm boundary lines. RESULTS: Mean age was 62 ± 13 years, 71% of patients were male, and 24% presented nonelectively. Hemiarch repair was performed in 80% and total arch replacement in 20%. There was a reduction in the incidence of the primary composite outcome over time (P1: 26%, P2: 23%, and P3: 16%; P = .010). Overall in-hospital mortality was 5% and remained stable throughout the 3 periods. Rates of stroke were lower in the late period (P1: 4%, P2: 6%, and P3: 2%; P = .035). Risk-adjusted cumulative sum analysis demonstrated that all surgeons remained within the 95% reassurance boundary throughout their experience, with 6 surgeons performing as expected and 2 performing better than expected. CONCLUSIONS: Early-career surgeons can safely perform operations with HCA from the initiation of their practice. The cumulative sum analysis method is valuable for monitoring competence in aortic surgery and could prove useful in structuring training programs.
Authors: Marina Ibrahim; Louis-Mathieu Stevens; Maral Ouzounian; Ali Hage; Francois Dagenais; Mark Peterson; Ismail El-Hamamsy; Munir Boodhwani; John Bozinovski; Michael C Moon; Michael H Yamashita; Rony Atoui; Bindu Bittira; Darrin Payne; Kevin Lachapelle; Michael W A Chu; Jennifer C-Y Chung Journal: CJC Open Date: 2021-05-12