A Longitudinal Study Exploring Junior Surgeons'' Practice-makes-perfect Effect between Volume and Outcome-Using Coronary Artery Bypass Graft Surgery as an Example
Date Issued
2008
Date
2008
Author(s)
Chang, Yu-Chia
Abstract
Background: In the past three decades, many “volume-outcome” studies have supported the hypothesis that higher volume was associated with better outcomes. However, most studies were based on cross-sectional design, and their results only demonstrated the association between volume and outcome, but not the effect of volume on outcome.urpose: This study aimed to examine the practice-makes-perfect effect on care outcomes by using longitudinal data to examine how the accumulated experience of Coronary Artery Bypass Graft Surgery (CABG) operation done by junior surgeon may affect patients’ health outcomes. ethods: Data came from 1997-2005 National Health Insurance Database. Patients received CABGs by junior surgeon between 2000 to 2005/06 were identified. Major health outcomes included in-hospital mortality rate, mortality rate during the period from admission to discharge, mortality rate during the period from admission to 30 days after discharge, and readmission rate within 30 days after discharge. Other outcomes, including length of length of hospital stay and medical fees, were also examined. Generalized Estimating Equations(GEE) were used to estimate the effect of volume on outcome after adjusting selected characteristics of patients, surgeons, and hospitals. esults: Sixty-eight junior surgeons performed CABGs for 3,063 patients during 2000 to 2005/06. All major health outcomes, except for readmission rate within 30 days after discharge, were significantly better among patients receiving CABGs as surgeons’ experience accumulated. In addition, surgeons’ volume was inversely associated with length of hospital stay and medical fees. Sensitivity analyses revealed the same results.onclusions: As junior surgeons’ CABGs experience accumulated, patients’ outcomes tend to become better. The finding supports the effect of "practice-makes-perfect" by junior surgeons performing CABGs.
Subjects
volume-outcome
practice-makes-perfect effect
Coronary Artery Bypass Graft Surgery
junior surgeon
longitudinal data
Type
thesis
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