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Estimation of mortality risk for vascular operations by trainees vs attending surgeons. J Surg Educ 2015 Jan-Feb;72(1):68-72

Date

12/17/2014

Pubmed ID

25498880

DOI

10.1016/j.jsurg.2014.07.007

Scopus ID

2-s2.0-84920683424   1 Citation

Abstract

OBJECTIVE: The development of the ability to estimate patient mortality preoperatively in surgical trainees has not been well studied.

DESIGN: Prospective comparative study in which the expected perioperative mortality risk and the maximum tolerable mortality at which operation would still be offered were estimated by the operating surgeons immediately before planned vascular procedures.

SETTING: University vascular surgery teaching service.

PARTICIPANTS: Predicted and maximum allowable mortality risks were compared between trainees and attending surgeons, with the mortality calculated using the Veterans Administration Surgical Quality Improvement Program (VASQIP) as a reference.

RESULTS: Surveys were performed before 379 procedures over a 10-month period. The median expected mortality risk predicted by trainees (2%; interquartile range [IQR]: 1%-5%) was higher than the risk predicted by attending surgeons (1%; IQR: 0.8%-3%) (p < 0.01). The median expected mortality risk calculated by VASQIP (0.8%; IQR: 0.4%-1.7%) was less than that estimated by trainees by a median of 0.3% (IQR: 0.2%-3.2%) or and that by attending surgeons by 0.3% (IQR: 0.2-1.3%) (p < 0.01). The median maximum tolerable mortality risk predicted by trainees (10%; IQR: 5%-27.5%) was equal to the risk predicted by attending surgeons (10%; IQR: 5%-17.5%). The perioperative mortality calculated by VASQIP exceeded the maximum tolerable mortality offered by trainees or attending surgeons in 1% of cases each. Discrepancies between expected mortality and maximum tolerable mortality for trainees and attending surgeons were greater for younger (postgraduate year 1 or 2) trainees (0.8%; IQR: 0-3.0%) than for more senior (postgraduate year 4 or 5) trainees (0.4%; IQR: 0.1%-2.0%).

CONCLUSION: Surgeons in training overestimated the perioperative mortality risk of operations and were willing to tolerate a greater mortality risk compared with attending surgeons. Both trainee and attending surgeons tended to overestimate the perioperative mortality risk compared with that calculated by VASQIP.

Author List

Pomposelli T, Hart J, Elliott B, Robison J, Brothers T

Author

Joseph Hart MD Associate Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adult
Clinical Competence
General Surgery
Humans
Internship and Residency
Medical Staff, Hospital
Prospective Studies
Risk Assessment
Vascular Surgical Procedures