Mortality and Severe Complications Among Newly Graduated Surgeons in the United States.

Objective: To evaluate severe complications and mortality over years of independent practice among general surgeons.
Background: Despite concerns that newly graduated general surgeons may be unprepared for independent practice, it is unclear whether patient outcomes differ between early and later career surgeons.
Methods: We used Medicare claims for patients discharged between July 1, 2007 and December 31, 2019 to evaluate 30-day severe complications and mortality for 26 operations defined as core procedures by the American Board of Surgery. Generalized additive mixed models were used to assess the association between surgeon years in practice and 30-day outcomes while adjusting for differences in patient, hospital, and surgeon characteristics.
Results: The cohort included 1,329,358 operations performed by 14,399 surgeons. In generalized mixed models, the relative risk (RR) of mortality was higher among surgeons in their first year of practice compared with surgeons in their 15th year of practice [5.5% (95% CI: 4.1%-7.3%) vs 4.7% (95% CI: 3.5%-6.3%), RR: 1.17 (95% CI: 1.11-1.22)]. Similarly, the RR of severe complications was higher among surgeons in their first year of practice compared with surgeons in their 15th year of practice [7.5% (95% CI: 6.6%-8.5%) versus 6.9% (95% CI: 6.1%-7.9%), RR: 1.08 (95% CI: 1.03-1.14)]. When stratified by individual operation, 21 operations had a significantly higher RR of mortality and all 26 operations had a significantly higher RR of severe complications in the first compared with the 15th year of practice.
Conclusions: Among general surgeons performing common operations, rates of mortality and severe complications were higher among newly graduated surgeons compared with later career surgeons.
Competing Interests: R.A.H. receives unrelated funding from the Blue Cross Blue Shield of Michigan Foundation and the National Institute of Diabetes and Digestive and Kidney Diseases (5T32DK108740-05). A.E.T. receives unrelated funding from the Ruth L Kirschstein Institutional National Service Award administered by the National Institutes of Health. C.S.B. receives unrelated funding from the Ruth L. Kirschstein Postdoctoral Research Fellowship Award administered by the National Institute on Drug Abuse (F32-DA050416). A.M.R. receives unrelated funding from the NIH and AHRQ. B.M. receives funding from the NIH. J.B.D. receives grant funding from the NIH, AHRQ, Blue Cross Blue Shield of Michigan Foundation, and is a cofounder of ArborMetrix, Inc. B.C.G received funding for this work from the Agency for Healthcare Research and Quality (AHRQ; 5K08HS027653-02) and receives unrelated funding from the National Board of Medical Examiners (NBME) Edward J. Stemmler M.D. Medical Education Research Fund, the American Board of Medical Specialties, the American Board of Family Medicine, and the Accreditation Council for Graduate Medical Education (ACGME). The remaining authors report no conflicts of interest.
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