title: Estimation of mortality risk for vascular operations by trainees vs attending surgeons.
abstract: OBJECTIVE
  The development of the ability to estimate patient mortality preoperatively in surgical trainees has not been well studied.
  
  
  METHODS
  Prospective comparative study in which the expected perioperative mortality risk and the maximum tolerable mortality at which operation would still be offered were estimated by the operating surgeons immediately before planned vascular procedures.
  
  
  METHODS
  University vascular surgery teaching service.
  
  
  METHODS
  Predicted and maximum allowable mortality risks were compared between trainees and attending surgeons, with the mortality calculated using the Veterans Administration Surgical Quality Improvement Program (VASQIP) as a reference.
  
  
  RESULTS
  Surveys were performed before 379 procedures over a 10-month period. The median expected mortality risk predicted by trainees (2%; interquartile range [IQR]: 1%-5%) was higher than the risk predicted by attending surgeons (1%; IQR: 0.8%-3%) (p < 0.01). The median expected mortality risk calculated by VASQIP (0.8%; IQR: 0.4%-1.7%) was less than that estimated by trainees by a median of 0.3% (IQR: 0.2%-3.2%) or and that by attending surgeons by 0.3% (IQR: 0.2-1.3%) (p < 0.01). The median maximum tolerable mortality risk predicted by trainees (10%; IQR: 5%-27.5%) was equal to the risk predicted by attending surgeons (10%; IQR: 5%-17.5%). The perioperative mortality calculated by VASQIP exceeded the maximum tolerable mortality offered by trainees or attending surgeons in 1% of cases each. Discrepancies between expected mortality and maximum tolerable mortality for trainees and attending surgeons were greater for younger (postgraduate year 1 or 2) trainees (0.8%; IQR: 0-3.0%) than for more senior (postgraduate year 4 or 5) trainees (0.4%; IQR: 0.1%-2.0%).
  
  
  CONCLUSIONS
  Surgeons in training overestimated the perioperative mortality risk of operations and were willing to tolerate a greater mortality risk compared with attending surgeons. Both trainee and attending surgeons tended to overestimate the perioperative mortality risk compared with that calculated by VASQIP.
authors.affiliation: Division of Vascular Surgery, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Thomas
authors.initials: T
authors.lastname: Pomposelli
authors.affiliation: Division of Vascular Surgery, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Joseph
authors.initials: J
authors.lastname: Hart
authors.affiliation: Division of Vascular Surgery, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Bruce
authors.initials: B
authors.lastname: Elliott
authors.affiliation: Division of Vascular Surgery, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Jacob
authors.initials: J
authors.lastname: Robison
authors.affiliation: Division of Vascular Surgery, Medical University of South Carolina, Charleston, South Carolina; Department of Veterans Affairs, Ralph H. Johnson VA Medical Center, Charleston, South Carolina. Electronic address: brothete@musc.edu.
authors.forename: Thomas
authors.initials: T
authors.lastname: Brothers
mesh_terms: D000328:Adult; D002983:Clinical Competence; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D008505:Medical Staff, Hospital; D011446:Prospective Studies; D018570:Risk Assessment; D014656:Vascular Surgical Procedures / Q000401:mortality*
keywords: Medical Knowledge; Patient Care; Practice-Based Learning and Improvement; education; mortality; surgery; training; vascular