Short-term outcome following cardiac surgery--a comparison between consultant and trainees' performance
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Morteza Tavakkoli Hosseini1, Imran Saeed, Kaushik Mandal
1Department of Cardiothoracic Surgery, St. George's Hospital, BlackShaw Road, London, SW17 0QT, UK.
Insights
Cardiac surgery outcomes were similar between trainees and consultants, despite trainees performing more urgent cases. This suggests supervised training effectively prepares surgeons for complex procedures.
Area of Science:
- Cardiology
- Surgical Training
- Outcomes Research
Background:
- Evaluating surgical trainee performance is crucial for patient safety.
- High-volume training centers offer unique insights into learning curves.
Purpose of the Study:
- To compare patient outcomes (mortality and morbidity) between cardiac operations performed by surgical trainees and consultant surgeons.
- To assess the safety and efficacy of surgical training programs in a high-volume cardiac surgery setting.
Main Methods:
- Retrospective analysis of 872 cardiac operations performed between January 2006 and March 2009.
- Comparison of hospital mortality and morbidity between consultant-led and trainee-led surgical teams.
- Statistical analysis of patient demographics, procedure types (including coronary artery bypass grafting), urgency, and risk scores (logistic EuroSCORE).
Main Results:
- Surgical trainees performed 21% of operations, including a higher proportion of urgent cases (32% vs. 23%).
- Overall mortality rates were comparable: 2.6% for consultants and 3.2% for trainees (P=NS).
- Coronary artery bypass grafting mortality was also similar: 1.7% for consultants and 4.2% for trainees (P=NS), with no significant difference in morbidity.
Conclusions:
- Cardiac operations performed by surgical trainees in a supervised, high-volume setting demonstrate comparable outcomes to those performed by consultants.
- The results suggest that experience and confidence, though difficult to quantify, may influence outcomes in surgical training.
- This study supports the effectiveness of structured training programs in achieving safe and successful patient care in cardiac surgery.
Abstract:
Comparison of the outcome of cardiac operations performed by surgical trainees with those performed by consultant surgeons has been an interesting topic in recent years. We set out to examine the outcome of a high volume-training firm. Cardiac operations performed by surgical trainees and a consultant between January 2006 and March 2009 were studied. Hospital mortality and morbidity were compared in the two groups. Eight hundred and seventy-two operations were performed, 687 (79%) were operated by consultant and 185 (21%) by surgical trainees. Mean logistic EuroSCORE in consultant and surgical trainees groups was 3.7 and 2.7, respectively (P<0.001). One hundred and forty-two (77%) of the cases performed by trainees were coronary artery bypass grafting (CABG). Interestingly, the ratio of urgent cases was higher in the trainees group [156 (23%) compared to 59 (32%), P=0.004]. Mortality in consultant and surgical trainees groups for all operations was 18 (2.6%) and six (3.2%), respectively (P=NS). Mortality for CABG in consultant and surgical trainees groups was six (1.7%) and six (4.2%), respectively (P=NS). There was no significant difference in morbidity outcome measures comparing the two groups. The non-significant higher overall mortality in operations performed by trainees in a fully supervised setting, may reflect the influence of experience and confidence, which are difficult to measure.
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