Less Experienced Surgeons May Increase Risk of Returning to Operating Room, Post-Surgical Complications: Study

Patients treated by emergency surgeons with less experience have a greater risk of experiencing post-surgical complications and requiring additional procedures, according to the findings of new research.

The importance of surgical experience and training was highlighted in a study published this month in the medical journal JAMA Surgery, indicating acute care surgeons may benefit from additional mentorship, especially during the initial stages of their careers.

Researchers evaluated data on 772 patients undergoing an emergency surgical procedure at one of five U.S. academic level 1 trauma medical centers where the same surgeons provided emergency general surgical care.

Patients presented with traumatic injury and required an emergency surgical procedure or presented with, or developed, a condition requiring an emergency general surgical intervention. They were operated on by one of 56 acute care surgeons.

Surgeon groups were divided by experience of less than 6 years, 6 to 10 years, 11 to 30 years, and 30 years or more from the end of training. A total of 618 surgeries were done by surgeons with less than 10 years of experience. Researchers focused on evaluating the association of surgeon experience with emergency surgery outcomes.

Overall, patient mortality, complications, postoperative transfusion, organ-space surgical site infection, and length of stay were similar between surgeon groups. However, patients operated on by early-career surgeons were more likely to need repeat surgeries when compared to patients operated on by early-midcareer surgeons, late-midcareer surgeons, and late-career surgeons.

Patients operated on by inexperienced surgeons with less than three years of experience had similar death rates compared with the rest of the surgeons, but they had higher rates of complications.

“Increased complications and unplanned return to the operating room may improve with experience,” the researchers concluded from the findings. “Early-career surgeons’ outcomes may be improved if they are supported while experience is garnered.”

Early- and late-midcareer surgeons generally operated on older patients and patients with more septic shock, acute kidney failure, and higher Emergency Surgery Scores. Surgeons with more experience often operated on patients who were already suffering from more severe conditions. Despite the higher risks, there were fewer complications among these surgeons.

The researchers explained that previous studies which compared surgeon experience with operating room outcomes have largely focused on administrative databases and did not focus on the complexity of the operation. Those studies also used smaller study groups.

The new research highlights a need for early career surgeons to receive more training and support early in their career to help improve outcomes for patients, the researchers determined.