Abstract 17020: Patient Mortality Affects a Surgeon’s Subsequent Performance

IntroductionStress affects performance and surgical case outcomes. Mortality in which a surgeon is intimately involved is a common stressor. Performance in specific cardiac surgeries can be measured using the hospital data collected for the Society of Thoracic Surgeons National Cardiac Database (STS NDS). The observed to expected mortality ratio (O/E) is a reliable measure of surgical performance. To anticipate surgeons’ performance deterioration after any mortality we measured the surgeon’s O/E in isolated coronary artery bypass graft surgery (isoCAB) in the 30 day period immediately following the mortality.MethodsOur Regional Collaborative collects all STS clinical records for 28 hospitals and 65 surgeons. From 2008-2014 17,823 isoCAB records were collected. Changes in the isoCAB O/E ratio was calculated for a given surgeon during the month following a surgical mortality. A logit-based model, with nonlinear temporal structure, was fitted to the data to show the duration of the performance change (change in isoCAB O/E) and how this effect is modified by the risk profiles of future cases. To better illustrate the effect of the stressor we divided surgeons into 3 groups based on their isoCAB O/E performance and looked at performance in Hi/Mod/Lo risk patients.ResultsThe baseline isoCAB O/E performances were different for each surgeon. There was a temporary increase in the O/E performance for all surgeons for approximately 1 week after a surgical mortality. The effect was seen observed beginning after the index event (patient’s mortality). The increase in O/E isoCABG was measurable in the low performing surgeon (high O/E) (28%). The effect was not discernable in high performing surgeons.ConclusionsSurgeon performance deteriorates after a mortality in any case the surgeon performs. The period of deterioration appears to be approximately one week.