Physician assistants work safely and efficiently as assistant surgeons during cardiac surgery, according to a small, single-site retrospective study. In an accompanying commentary, a cardiothoracic surgeon describes cardiovascular physician assistants as “our invaluable surgical partners in every sense of the word” who are not adequately recognized by hospitals and payers.
The analysis and commentary appeared in the Aug. 10 issue of the Journal of the American Academy of Physician Assistants.
Edward A. Ranzenbach, PA-C, senior physician assistant at the University of California, Davis, division of cardiothoracic surgery in Sacramento, Calif., and colleagues designed their analysis to explore the role of the physician assistant during cardiac surgery. For their study, they identified 956 patients whose surgical procedures were first assisted by a physician assistant or first assisted by a surgeon. All cases took place at the Enloe Medical Center in Chico, Calif.
They used Euro scores and predicted mortality to compare overall risk of surgery. Risk scores for the two groups were similar but physician assistants assisted in fewer cases, at 208 compared with 748 for surgeons.
About a third of the surgeon-assisted group did not require extracorporeal bypass while about two-thirds of the physician assistant-assisted group were off-pump.
“An analysis of cases by incidence and provider showed no significant differences between the groups,” Ranzenbach et al wrote. “This would indicate that there was no attempt by the primary surgeon to delay a reoperative case until a physician/surgeon assistant was available and demonstrates confidence by the primary surgeon in the PA's [physician assistant’s] ability to assist even these more difficult cases.”
Operating room time was less for physician assistants, at 4.09 hours vs. 4.95 hours for surgeon assistants. The authors attributed the shorter time to the number of off-pump procedures in the physician assistant group. Incision time also was shorter in the physician assistant group, at 167.5 minutes vs. 205.9 minutes. Incision time for on-pump cases was similar for the two groups. After accounting for differences in off-pump cases, complications were not significantly different.
Ranzenbach and colleagues acknowledged that as a small, single-center study, their results are not generalizable. But their findings may provide a basis for a randomized controlled clinical trial, they wrote.
Anthony P. Furnary, MD, senior cardiothoracic surgeon and chief operating officer of Starr-Wood Cardiac Group in Portland, Ore., wrote that cardiovascular physician assistants have been an integral part of surgery teams, whether performing endoscopic saphenous vein harvesting in the 1990s or assisting with CABG grafts, valves, aortic dissections, thoracotomies and other surgeries in the present time.
“Unfortunately, the impact that CVPAs [cardiovascular physician assistants] have had on excellent outcomes and patient and physician satisfaction in cardiothoracic surgery, while still minimizing the economic impact to our healthcare system costs, has not been widely recognized by those agencies that fund our mutual reimbursement, be they insurers, governmental agencies, hospitals or employers,” he wrote, concluding that the findings by Ranzenbach et al may help to change that.