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A National Comparison of Operative Outcomes of New and Experienced Surgeons

Kelz, Rachel R. MD, MSCE, MBA, FACS*,†; Sellers, Morgan M. MD*; Niknam, Bijan A. BS; Sharpe, James E. MS; Rosenbaum, Paul R. PhD†,§; Hill, Alexander S. BS; Zhou, Hong MS; Hochman, Lauren L. BA; Bilimoria, Karl Y. MD, MS; Itani, Kamal MD||,#; Romano, Patrick S. MD, MPH, FACP, FAAP**; Silber, Jeffrey H. MD, PhD†,‡,††,‡‡,§§

doi: 10.1097/SLA.0000000000003388
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Objective: To determine whether outcomes achieved by new surgeons are attributable to inexperience or to differences in the context in which care is delivered and patient complexity.

Background: Although prior studies suggest that new surgeon outcomes are worse than those of experienced surgeons, factors that underlie these phenomena are poorly understood.

Methods: A nationwide observational tapered matching study of outcomes of Medicare patients treated by new and experienced surgeons in 1221 US hospitals (2009–2013). The primary outcome studied is 30-day mortality. Secondary outcomes were examined.

Results: In total, 694,165 patients treated by 8503 experienced surgeons were matched to 68,036 patients treated by 2119 new surgeons working in the same hospitals. New surgeons’ patients were older (25.8% aged ≥85 vs 16.3%,P<0.0001) with more emergency admissions (53.9% vs 25.8%,P<0.0001) than experienced surgeons’ patients. Patients of new surgeons had a significantly higher baseline 30-day mortality rate compared with patients of experienced surgeons (6.2% vs 4.5%,P<0.0001;OR 1.42 (1.33, 1.52)). The difference remained significant after matching the types of operations performed (6.2% vs 5.1%, P<0.0001; OR 1.24 (1.16, 1.32)) and after further matching on a combination of operation type and emergency admission status (6.2% vs 5.6%, P=0.0007; OR 1.12 (1.05, 1.19)). After matching on operation type, emergency admission status, and patient complexity, the difference between new and experienced surgeons’ patients’ 30-day mortality became indistinguishable (6.2% vs 5.9%,P=0.2391;OR 1.06 (0.97, 1.16)).

Conclusions: Among Medicare beneficiaries, the majority of the differences in outcomes between new and experienced surgeons are related to the context in which care is delivered and patient complexity rather than new surgeon inexperience.

*Department of Surgery, Center for Surgery and Health Economics, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA

The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA

Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, PA

§Department of Statistics, The Wharton School, The University of Pennsylvania, Philadelphia, PA

Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Northwestern Medicine, Chicago IL

||VA Boston Health Care System, Boston, MA

#Department of Surgery, Boston University School of Medicine, Boston, MA

**Division of General Medicine and Center for Healthcare Policy and Research, University of California Davis School of Medicine, Sacramento, CA

††The Departments of Pediatrics, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA

‡‡Department of Anesthesiology and Critical Care, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA

§§Department of Health Care Management, The Wharton School, The University of Pennsylvania, Philadelphia, PA.

Reprints: Rachel R. Kelz, MD, MSCE, MBA, FACS, Professor of Surgery, Center of Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Perelman School of Medicine, 3400 Spruce Street, 4 Silverstein, Philadelphia, PA 19104. E-mail: rachel.kelz@uphs.upenn.edu.

All phases of this study were supported by National Institute on Aging/National Institutes of Health grant R01 AG049757. NIA/NIH had no role in the design or conduct of the study; collection, management, analysis, or interpretation of the data; or preparation, review, or approval of the manuscript to submit for publication.

The authors report no conflicts of interest.

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