Introduction
Several surgeon-related factors are known to be associated with surgical
outcomes. Surgeon years in practice is one of these factors, with some
reports suggesting a concave relationship on complex cases, in which
outcomes of early-career surgeons improve for the first number of years
in practice, stabilize for the middle of their career, and finally
decline for very late career surgeons1–3. Such
findings may suggest the importance of triaging cases of different
complexity to surgeons of different experience levels. However, it
remains unknown if the composition of cases in terms of patient risk
profile changes with surgeons’ number of years in practice.
There have been very few studies on this topic, however the little
evidence that exists in general surgery points to earlier-career
surgeons receiving more challenging and higher-risk
cases4–6. In cardiac surgery, a prior study showed
that surgeons with lower risk-adjusted mortality rates tended to perform
CABG surgery on higher risk patients7. Additionally,
it has been shown that experienced surgeons with 9-17 years in practice
may perform best on highly complex reoperative cases1.
However, it is unknown if complex cases are distributed in a way that
would optimize patient care in light of this observed trend. The
relationship between cardiac surgeon experience and case complexity
remains unclear in a field with high risk operations that may warrant
further examination.