Surgeon case conferencing in elective aortic surgery

BACKGROUND: Surgeon case conferences (SCCs) involve same-phenotype surgeons (i.e., surgeons who perform similar procedures such as orthopedic or vascular surgeons) meeting to discuss upcoming consecutive cases; other specialties are excluded to ensure a focus on surgical considerations. Given that some studies found that SCCs sometimes led to treatment plan changes among patients with gastrointestinal malignancies, we sought to test SCCs in vascular surgery. METHODS: A pre-study workshop with researchers and vascular surgeons at a single institution produced relevant SCC elements, including the decision to focus on aortic procedures; definitions of major (e.g., convert from open to endovascular approach) and minor (e.g., additional preoperative testing) treatment changes; and an aortic SCC form. The form facilitated collection of data related to the initial treatment plan, the consensus treatment plan, and a description of treatment plan changes. During subsequent SCCs, for each patient, the primary surgeon presented their initial treatment plan, a confidence score for this plan (on a Likert scale of 1 to 5, from no to high confidence), and patient details. Subsequent group discussion produced a consensus treatment plan and a description of any plan changes. Study outcomes included rates of major and minor change from the primary surgeon's initial plan to the consensus plan, and confidence scores for patients with and without a plan change. RESULTS: Six vascular surgeons from a single academic hospital with a high procedure volume reviewed 100 consecutive patients during 33 aortic SCCs over a 10-month period. The rate of change from initial to consensus treatment plans was 39%. Rates of major and minor changes were 10% and 29%, respectively. Patient and treatment measures were similar for patients with and without a treatment change. Confidence scores for initial treatment plans were similar for patients with and without a change (median score 4 and 5, respectively; p = 0.09). CONCLUSION: A structured SCC changed 39% of primary vascular surgeons' initial treatment plans related to aortic procedures, even though confidence scores in initial treatment plans were similar for patients with and without changes. Our results suggest that vascular surgeons should seek structured input from colleagues for all patient cases not just those they perceive as challenging.