Training Cardiac Surgeons: Safety and Requirements

Area of Science:

• Cardiovascular Surgery
• Surgical Education
• Patient Safety

Background:

• Assessing the safety and efficacy of cardiac surgical residents performing complex procedures is crucial for surgical training.
• Coronary artery bypass grafting (CABG) is a common cardiac surgery where resident performance needs evaluation.

Purpose of the Study:

• To determine if cardiac surgical residents can perform CABG without compromising patient safety or outcomes.
• To compare the performance and results of residents with those of senior surgeons.

Main Methods:

• Retrospective analysis of 16,486 CABG procedures performed between 2002 and 2020.
• Surgeons categorized into five groups based on experience: senior, attending, fellow, advanced residents, and new residents.
• Multivariable analysis of primary (30-day mortality) and secondary endpoints (intra- and post-operative complications).

Main Results:

• No significant differences in 30-day mortality or other patient outcomes were found between resident and senior surgeon groups.
• New residents required approximately 30% longer skin-to-skin time compared to senior surgeons (234 vs. 180 minutes).
• Multivariable analysis confirmed comparable patient safety and outcomes across experience levels.

Conclusions:

• Cardiac surgical residents can perform CABG procedures safely and effectively with appropriate supervision.
• Patient selection, adequate resources, and longer surgical times support successful resident performance.
• Surgical training programs can integrate residents into complex procedures without negatively impacting patient outcomes.