Low Surgical Skill Rating of Surgeons Increased Complication Rates of Patients after Coronary Artery Bypass Graft

Objectives It is not well characterized how surgeon-level factors affect surgical outcomes. This study aimed to determine the relationship between surgical skill rating of a cardiac surgeon and complication rates after coronary artery bypass grafting (CABG). Methods Video-based evaluations of CABG performed by 46 senior surgeons were conducted by 13 blinded expert cardiac surgeons. The evaluations were carried out using a rating score sheet including 7 domains of skills in surgical skills. Other surgeon-level factors such as the demographic information, Myers-Briggs Type Indicator (MBTI) test and the ratio of low frequency and high frequency of heart rate variability (LF/HF) during operation were also collected. The association between surgical skill rating along with surgeon-level factors and surgical outcomes was examined using prospectively collected data. The primary outcome was major adverse cardiac and cerebrovascular event (MACCE), included mortality, myocardial infarction and stroke within 30-day after surgery. The secondary outcome included skill-related complications and all complications. Multivariable generalized linear mixed models were employed for surgical skill rating on MACCE, skill-related complications and all complications. Results From 2018 to 2021, the participants performed a total of 9,844 isolated CABGs. All participant surgeons were male with a median of CABG volume of 702. Based on three reviewers per video and with a maximum surgical skill score of 5, the average surgical skill scores ranged from 3.10 to 4.81. After adjusted with the risk factors of the patients, compared to the patients of the top quartile rating surgeons, the patients of bottom quartile rating surgeons had 1.381 times of risk in MACCE (95%CI, 1.098-1.735, p=0.006), 1.528 times of risk in skill-related complication (95%CI, 1.340-1.743, p<0.001) and 1.286 times of risk in all complication (95%CI, 1.131-1.463, p<0.001). Surgeons in the top quartile of skill rating had an older age (57.9±4.4 vs. 49.7±5.7, p=0.002), higher rate of “sensing” characteristics of MBTI (72.7% vs. 33.3, p=0.046), lower rate of “thinking” characteristics of MBTI (54.5% vs. 83.3%, p=0.013), higher mean annual volumes of CABG (109.3±57.7 vs. 41.5±25.0 p=0.001), and lower LF/HF (2.3±0.1 vs. 4.9±1.4 p<0.01) than in the bottom quartile of skill rating. Conclusion Lower surgical skill rating of cardiac surgeon appeared to be associated with higher complication rates for CABGs. The surgical skill rating correlated well with a series of surgeon-level factors. Efforts to improve surgeon surgical skills may result in better patient outcomes and surgeon characteristics may serve as the target of intervention for quality improvements.