The Critical Transition in Surgical Experience: Impact of the Early Years of Surgical Practice on Perioperative Outcomes and Team Collaboration.

Abstract

Surgical experience and team structure play critical roles in determining perioperative outcomes. The early years of surgical practice represent a transition phase during which mentorship and case selection are essential to optimize patient safety while developing technical skills. A retrospective cohort study was conducted to analyze 1123 surgeries performed by a single surgeon alone (S), in collaboration with a senior co-surgeon (S + S), or with a junior co-surgeon (S + J) during the first five years of independent practice. Perioperative parameters and postoperative outcomes were compared across groups. Multivariate Cox regression was used to identify risk factors associated with high Clavien-Dindo complications (grade > 2), in-hospital mortality, and overall mortality. Surgeries in the S + S group involved the most complex cases, with significantly longer operative times, greater blood loss, and higher rates of complications and mortality. Multivariate analysis identified upper GI surgery, high ASA class, emergency surgery, and malignancy as independent predictors of adverse outcomes. In contrast, laparoscopic surgery and breast procedures were protective. Importantly, surgeons with < 3 years of experience had significantly higher overall mortality risk (HR 2.73, p < 0.001). The S + J group demonstrated intermediate outcomes, suggesting that junior involvement under appropriate supervision maintains patient safety while supporting skill development. The first 3 years of surgical practice represent a critical learning phase. Although complication rates decrease with experience, increased case complexity in later years requires ongoing support. Structured mentorship and progressive case exposure are key to ensuring safe and effective transitions from trainee to independent surgeon.