Evidence map›Paper›PMID 28710297›Full record

ArticleCirculation. Cardiovascular quality and outcomes2017

Association of Surgeon Age and Experience With Congenital Heart Surgery Outcomes.

Brett R Anderson, Amelia S Wallace, Kevin D Hill, Brian C Gulack, Roland Matsouaka, Jeffrey P Jacobs, Emile A Bacha, Sherry A Glied, Marshall L Jacobs

Abstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Circulation. Cardiovascular quality and outcomes, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
18citing papers in PubMed, 1 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

18 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Comparison of early outcomes of coronary artery bypass grafting between junior and senior surgeons.Kardiochirurgia i torakochirurgia polska = Polish journal of cardio-thoracic surgery · 2026
    Article
  3. Article
  4. Article
  5. Article
  6. Article
  7. Observational
  8. Article
  9. Article
  10. Article
  11. Article
  12. Article
  13. Article
  14. Article
  15. Relation between surgeon age and postoperative outcomes: a population-based cohort study.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2020
    Article
  16. The Congenital Heart Technical Skill Study: Rationale and Design.World journal for pediatric & congenital heart surgery · 2019
    Article
  17. Article
  18. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors.

Brett R AndersonFrom the Division of Pediatric Cardiology, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Medical Center (B.R.A.); Duke Clinical Research Institute, Durham, NC (A.S.W.); Department of Pediatrics, Duke Clinical Research Institute (K.D.H.) and Department of Surgery (B.C.G.), Duke University Medical Center, Durham, NC; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC (R.M.); Division of Cardiovascular Surgery, Department of Surgery, Johns Hopkins All Children's Heart Institute, St. Petersburg, FL (J.P.J., M.L.J.); Division of Cardiac Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD (J.P.J., M.L.J.); Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York, NY (E.A.B.); and The Robert F. Wagner Graduate School of Public Service, New York University (S.A.G.). bra2113@cumc.columbia.edu.
Amelia S WallaceFrom the Division of Pediatric Cardiology, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Medical Center (B.R.A.); Duke Clinical Research Institute, Durham, NC (A.S.W.); Department of Pediatrics, Duke Clinical Research Institute (K.D.H.) and Department of Surgery (B.C.G.), Duke University Medical Center, Durham, NC; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC (R.M.); Division of Cardiovascular Surgery, Department of Surgery, Johns Hopkins All Children's Heart Institute, St. Petersburg, FL (J.P.J., M.L.J.); Division of Cardiac Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD (J.P.J., M.L.J.); Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York, NY (E.A.B.); and The Robert F. Wagner Graduate School of Public Service, New York University (S.A.G.).
Kevin D HillFrom the Division of Pediatric Cardiology, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Medical Center (B.R.A.); Duke Clinical Research Institute, Durham, NC (A.S.W.); Department of Pediatrics, Duke Clinical Research Institute (K.D.H.) and Department of Surgery (B.C.G.), Duke University Medical Center, Durham, NC; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC (R.M.); Division of Cardiovascular Surgery, Department of Surgery, Johns Hopkins All Children's Heart Institute, St. Petersburg, FL (J.P.J., M.L.J.); Division of Cardiac Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD (J.P.J., M.L.J.); Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York, NY (E.A.B.); and The Robert F. Wagner Graduate School of Public Service, New York University (S.A.G.).
Brian C GulackFrom the Division of Pediatric Cardiology, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Medical Center (B.R.A.); Duke Clinical Research Institute, Durham, NC (A.S.W.); Department of Pediatrics, Duke Clinical Research Institute (K.D.H.) and Department of Surgery (B.C.G.), Duke University Medical Center, Durham, NC; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC (R.M.); Division of Cardiovascular Surgery, Department of Surgery, Johns Hopkins All Children's Heart Institute, St. Petersburg, FL (J.P.J., M.L.J.); Division of Cardiac Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD (J.P.J., M.L.J.); Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York, NY (E.A.B.); and The Robert F. Wagner Graduate School of Public Service, New York University (S.A.G.).
Roland MatsouakaFrom the Division of Pediatric Cardiology, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Medical Center (B.R.A.); Duke Clinical Research Institute, Durham, NC (A.S.W.); Department of Pediatrics, Duke Clinical Research Institute (K.D.H.) and Department of Surgery (B.C.G.), Duke University Medical Center, Durham, NC; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC (R.M.); Division of Cardiovascular Surgery, Department of Surgery, Johns Hopkins All Children's Heart Institute, St. Petersburg, FL (J.P.J., M.L.J.); Division of Cardiac Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD (J.P.J., M.L.J.); Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York, NY (E.A.B.); and The Robert F. Wagner Graduate School of Public Service, New York University (S.A.G.).
Jeffrey P JacobsFrom the Division of Pediatric Cardiology, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Medical Center (B.R.A.); Duke Clinical Research Institute, Durham, NC (A.S.W.); Department of Pediatrics, Duke Clinical Research Institute (K.D.H.) and Department of Surgery (B.C.G.), Duke University Medical Center, Durham, NC; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC (R.M.); Division of Cardiovascular Surgery, Department of Surgery, Johns Hopkins All Children's Heart Institute, St. Petersburg, FL (J.P.J., M.L.J.); Division of Cardiac Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD (J.P.J., M.L.J.); Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York, NY (E.A.B.); and The Robert F. Wagner Graduate School of Public Service, New York University (S.A.G.).
Emile A BachaFrom the Division of Pediatric Cardiology, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Medical Center (B.R.A.); Duke Clinical Research Institute, Durham, NC (A.S.W.); Department of Pediatrics, Duke Clinical Research Institute (K.D.H.) and Department of Surgery (B.C.G.), Duke University Medical Center, Durham, NC; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC (R.M.); Division of Cardiovascular Surgery, Department of Surgery, Johns Hopkins All Children's Heart Institute, St. Petersburg, FL (J.P.J., M.L.J.); Division of Cardiac Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD (J.P.J., M.L.J.); Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York, NY (E.A.B.); and The Robert F. Wagner Graduate School of Public Service, New York University (S.A.G.).
Sherry A GliedFrom the Division of Pediatric Cardiology, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Medical Center (B.R.A.); Duke Clinical Research Institute, Durham, NC (A.S.W.); Department of Pediatrics, Duke Clinical Research Institute (K.D.H.) and Department of Surgery (B.C.G.), Duke University Medical Center, Durham, NC; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC (R.M.); Division of Cardiovascular Surgery, Department of Surgery, Johns Hopkins All Children's Heart Institute, St. Petersburg, FL (J.P.J., M.L.J.); Division of Cardiac Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD (J.P.J., M.L.J.); Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York, NY (E.A.B.); and The Robert F. Wagner Graduate School of Public Service, New York University (S.A.G.).
Marshall L JacobsFrom the Division of Pediatric Cardiology, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Medical Center (B.R.A.); Duke Clinical Research Institute, Durham, NC (A.S.W.); Department of Pediatrics, Duke Clinical Research Institute (K.D.H.) and Department of Surgery (B.C.G.), Duke University Medical Center, Durham, NC; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC (R.M.); Division of Cardiovascular Surgery, Department of Surgery, Johns Hopkins All Children's Heart Institute, St. Petersburg, FL (J.P.J., M.L.J.); Division of Cardiac Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD (J.P.J., M.L.J.); Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York, NY (E.A.B.); and The Robert F. Wagner Graduate School of Public Service, New York University (S.A.G.).

Funding

Clinical and Translational Science AwardUL1TR001873 · NCATS · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI REILLY, MUREDACH P · 2016 to 2025
$99.0M
Institutional Career Development CoreKL2TR001874 · NCATS · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI GENKINGER, JEANINE M., SHIMBO, DAICHI · 2016 to 2025
$13.6M
Duke CTSA (Composite)KL2TR001115 · NCATS · DUKE UNIVERSITY · PI BOULWARE, LEIGH E, KRAFT, MONICA · 2013 to 2017
$5.1M
NCATS NIH HHS KL2 TR001115NCATS NIH HHS KL2 TR001874NCATS NIH HHS UL1 TR001873
6 · The paper itself

Abstract

backgroundSurgeon experience concerns both families of children with congenital heart disease and medical providers. Relationships between surgeon seniority and patient outcomes are often assumed, yet there are little data. METHODS AND

resultsThis national study used linked data from the American Medical Association Physician Masterfile and the Society of Thoracic Surgeons-Congenital Heart Surgery Database to examine associations between surgeon years since medical school and major morbidity/mortality for children undergoing cardiac surgery. Sensitivity analyses explored the effects of patient characteristics, institutional/surgeon volumes, and various measures of institutional surgeon team experience. In secondary analyses, major morbidity and mortality were examined as separate end points. We identified 206 congenital heart surgeons from 91 centers performing 62 851 index operations (2010-2014). Median time from school was 25 years (range 9-55 years). A major morbidity/mortality occurred in 11.5% of cases. In multivariable analyses, the odds of major morbidity/mortality were similar for early-career (<15 years from medical school, ≈<40 years old), midcareer (15-24 years, ≈40-50 years old), and senior surgeons (25-35 years, ≈50-60 years old). The odds of major morbidity/mortality were ≈25% higher for operations performed by very senior surgeons (35-55 years from school, ≈60-80 years old; n=9044 cases). Results were driven by differences in morbidity. In extensive sensitivity analyses, these effects remained constant.

conclusionsIn this study of >200 congenital heart surgeons, we found patient outcomes for surgeons with the fewest years of experience to be comparable to those of their midcareer and senior colleagues, within the context of existing referral and support practices. Very senior surgeons had higher risk-adjusted odds of major morbidity/mortality. Contemporary approaches to training, referral, mentoring, surgical planning, and other support practices might contribute to the observed outcomes of junior congenital heart surgeons being comparable to those of more experienced colleagues. Understanding and disseminating these practices might benefit the medical community at large.

Indexed as

Cardiac Surgical ProceduresClinical CompetenceSurgeonsAdultAgedAged, 80 and overAge FactorsChi-Square DistributionDatabases, FactualEducation, MedicalHeart Defects, CongenitalHumansLogistic ModelsMentorsMiddle AgedMultivariate Analysishealth care quality, access, and evaluationheart defects, congenitalmentoringsurgeons

Identifiers

PMID28710297
PMCPMC5656266

What OpenQuestion holds

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Registered trials

None linked

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.