Developing skills for thoracic aortic surgery with hypothermic circulatory arrest.

Area of Science:

• Cardiovascular Surgery
• Surgical Education
• Patient Safety

Background:

• Hypothermic circulatory arrest (HCA) is a critical technique in complex aortic surgeries.
• Evaluating the learning curve for early-career surgeons is essential for ensuring patient safety and optimizing outcomes.
• Standardized performance monitoring can identify areas for improvement in surgical training.

Purpose of the Study:

• To assess the performance trajectories of 8 novice aortic surgeons utilizing HCA.
• To determine the influence of the learning curve on perioperative complications in aortic reconstruction.
• To validate the utility of risk-adjusted cumulative sum analysis in monitoring surgical competence.

Main Methods:

• Analysis of 1025 consecutive aortic reconstruction patients undergoing HCA (2002-2017).
• Subdivision of the cohort into three distinct time periods to track learning progression.
• Application of risk-adjusted cumulative sum (CUSUM) analysis to evaluate surgeon performance against predefined boundaries.

Main Results:

• A significant reduction in the composite adverse outcome rate was observed over time (26% to 16%).
• In-hospital mortality remained stable at 5%, while stroke rates decreased in the later period (4% to 2%).
• CUSUM analysis indicated all surgeons operated within acceptable safety margins, with two outperforming expectations.

Conclusions:

• Early-career surgeons can safely initiate HCA procedures upon commencing practice.
• The CUSUM methodology is effective for monitoring surgeon performance and competency in aortic surgery.
• This approach can inform the development and refinement of surgical training programs.