ArticleHealth services research2009
Learning by doing, scale effects, or neither? Cardiac surgeons after residency.
Article in Health services research, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
8 citing papers in PubMed.
- Organizational learning-by-doing in liver transplantation.International journal of health economics and management · 2018Article
- Association of Surgeon Age and Experience With Congenital Heart Surgery Outcomes.Circulation. Cardiovascular quality and outcomes · 2017Article
- Measuring the Volume-Outcome Relation for Complex Hospital Surgery.Applied health economics and health policy · 2016Article
- Observational
- On the Hospital Volume and Outcome Relationship: Does Specialization Matter More Than Volume?Health services research · 2015Article
- Renal transplantation: relationship between hospital/surgeon volume and postoperative severe sepsis/graft-failure. a nationwide population-based study.International journal of medical sciences · 2014Article
- Practice variation, bias, and experiential learning in cesarean delivery: a data-based system dynamics approach.Health services research · 2013Article
- Association between physicians' experience after training and maternal obstetrical outcomes: cohort study.BMJ (Clinical research ed.) · 2013Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
1 author.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo examine impacts of operating surgeon scale and cumulative experience on postoperative outcomes for patients treated with coronary artery bypass grafts (CABG) by "new" surgeons. Pooled linear, fixed effects panel, and instrumented regressions were estimated. DATA SOURCES: The administrative data included comorbidities, procedures, and outcomes for 19,978 adult CABG patients in Florida in 1998-2006, and public data on 57 cardiac surgeons who completed residencies after 1997. STUDY
designAnalysis was at the patient level. Controls for risk, hospital scale and scope, and operating surgeon characteristics were made. Patient choice model instruments were constructed. Experience was estimated allowing for "forgetting" effects. PRINCIPAL
findingsPanel regressions with surgeon fixed effects showed neither surgeon scale nor cumulative volumes significantly impacted mortality nor consistently impacted morbidity. Estimation of "forgetting" suggests that almost all prior experience is depreciated from one quarter to the next. Instruments were strong, but exogeneity of volume was not rejected.
conclusionsIn postresidency surgeons, no persuasive evidence is found for learning by doing, scale, or selection effects. More research is needed to support the cautious view that, for these "new" cardiac surgeons, patient volume could be redistributed based on realized outcomes without disruption.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.