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Comment & Response
August 4, 2021

Concerns Regarding Surgeon Special Interest and Years Following Termination of Training—Reply

Author Affiliations
  • 1Department of Surgery, Yale School of Medicine, New Haven, Connecticut
JAMA Surg. 2021;156(12):1182-1183. doi:10.1001/jamasurg.2021.3621

In Reply We thank Pan et al and Hoh and Hong for their insights into our recent analysis of the association of acute care surgery patient outcomes with surgeon experience.1 Their points are important, and we would like to address their concerns. We agree with the authors with respect to a lack of association of surgical experience with simpler cases, such as cholecystectomy and appendectomy. However, the majority of surgical literature covering this topic focuses on complex cases including pancreatectomy and carotid endarterectomy where surgical experience does affect outcomes. We believe this alone justifies our exclusion of these cases. We also agree that individual surgeon volume may influence outcomes; however, we did not have these data for all cases a surgeon may have performed. We did report the majority of junior surgeons as having overall low volumes with respect to complex acute care surgery. It is unlikely that many junior surgeons had high volumes of other types of cases, especially complex cases. Therefore, we agree that poorer outcomes by junior surgeons could also be indirectly associated with their status as a junior surgeon with generally low volumes of elective cases.

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