Evidence map›Paper›PMID 27444190›Full record

ArticleBMJ (Clinical research ed.)2016

Surgeon specialization and operative mortality in United States: retrospective analysis.

Nikhil R Sahni, Maurice Dalton, David M Cutler, John D Birkmeyer, Amitabh Chandra

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ (Clinical research ed.), 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 61 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
61citing papers in PubMed, 5 pooled it
–field-weighted citation impact
1 · What the graph read from it

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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

61 citing papers in PubMed, 5 syntheses or guidelines pooled it.

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1 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

5 authors.

Nikhil R SahniDepartment of Economics, Harvard University, Cambridge, MA, USA McKinsey and Company, Boston, MA, USA nikhilsahni@fas.harvard.edu.
Maurice DaltonNational Bureau of Economic Research, Cambridge, MA, USA.
David M CutlerDepartment of Economics, Harvard University, Cambridge, MA, USA National Bureau of Economic Research, Cambridge, MA, USA.
John D BirkmeyerDartmouth-Hitchcock Health System, Lebanon, NH, USA Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA.
Amitabh ChandraNational Bureau of Economic Research, Cambridge, MA, USA Harvard Kennedy School, Cambridge, MA, USA.

Funding

UNDERSTANDING AND IMPROVING EPISODE-BASED HOSPITAL CAREP01AG019783 · NIA · DARTMOUTH COLLEGE · PI Inas S Khayal · 2001 to 2026
$52.9M
NIA NIH HHS P01 AG019783
6 · The paper itself

Abstract

objectiveTo measure the association between a surgeon's degree of specialization in a specific procedure and patient mortality.

designRetrospective analysis of Medicare data.

settingUS patients aged 66 or older enrolled in traditional fee for service Medicare.

participants25 152 US surgeons who performed one of eight procedures (carotid endarterectomy, coronary artery bypass grafting, valve replacement, abdominal aortic aneurysm repair, lung resection, cystectomy, pancreatic resection, or esophagectomy) on 695 987 patients in 2008-13.

main outcome measureRelative risk reduction in risk adjusted and volume adjusted 30 day operative mortality between surgeons in the bottom quarter and top quarter of surgeon specialization (defined as the number of times the surgeon performed the specific procedure divided by his/her total operative volume across all procedures).

resultsFor all four cardiovascular procedures and two out of four cancer resections, a surgeon's degree of specialization was a significant predictor of operative mortality independent of the number of times he or she performed that procedure: carotid endarterectomy (relative risk reduction between bottom and top quarter of surgeons 28%, 95% confidence interval 0% to 48%); coronary artery bypass grafting (15%, 4% to 25%); valve replacement (46%, 37% to 53%); abdominal aortic aneurysm repair (42%, 29% to 53%); lung resection (28%, 5% to 46%); and cystectomy (41%, 8% to 63%). In five procedures (carotid endarterectomy, valve replacement, lung resection, cystectomy, and esophagectomy), the relative risk reduction from surgeon specialization was greater than that from surgeon volume for that specific procedure. Furthermore, surgeon specialization accounted for 9% (coronary artery bypass grafting) to 100% (cystectomy) of the relative risk reduction otherwise attributable to volume in that specific procedure.

conclusionFor several common procedures, surgeon specialization was an important predictor of operative mortality independent of volume in that specific procedure. When selecting a surgeon, patients, referring physicians, and administrators assigning operative workload may want to consider a surgeon's procedure specific volume as well as the degree to which a surgeon specializes in that procedure.

Indexed as

SpecializationSurgeonsAgedCardiovascular Surgical ProceduresClinical CompetenceFemaleHospital MortalityHumansMaleMedicareNeoplasmsOutcome Assessment, Health CareRetrospective StudiesSurgical Procedures, OperativeUnited States

Identifiers

PMID27444190
PMCPMC4957587

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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.