Long-term results of heart operations performed by surgeons-in-training

Area of Science:

• Cardiovascular Surgery
• Surgical Education
• Patient Outcomes

Background:

• Assessing the impact of surgical trainees on patient outcomes is crucial for quality assurance in cardiac surgery.
• Supervised operations by residents may involve different risk profiles compared to cases performed solely by staff surgeons.

Purpose of the Study:

• To investigate the association between cardiac surgeries performed by trainees and both in-hospital and late patient outcomes.
• To compare the safety and efficacy of procedures with residents as primary operators versus staff surgeons.

Main Methods:

• Prospective data collection on coronary artery bypass graft surgery and/or aortic valve replacement from 1998-2005.
• Comparison of in-hospital mortality and a composite outcome (mortality, stroke, bleeding, etc.) between teaching (n=1054) and non-teaching cases (n=5877).
• Logistic regression and Cox proportional hazards regression used to adjust for baseline risk and analyze late survival and cardiovascular readmissions.

Main Results:

• Resident cases were more likely to present with high-risk features (e.g., depressed ventricular function, redo operations, urgent procedures).
• Resident primary operator status was not independently associated with in-hospital mortality (OR 1.09) or the composite outcome (OR 1.01).
• Kaplan-Meier survival and Cox regression showed equivalent event-free survival and no association with late death or cardiovascular rehospitalization (HR 1.05).

Conclusions:

• Cardiac surgery cases performed by senior residents often have greater complexity and acuity.
• Patient outcomes, both short-term and long-term, were similar between cases performed by residents and staff surgeons.
• Allowing residents to perform cardiac surgery under supervision is not linked to adverse patient outcomes.