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Are there differences in cardiothoracic surgery performed by trainees versus fully trained surgeons?
Maria Comanici1,2, Mohammad Yousuf Salmasi1, Katharina L Schulte3
1Department of Cardiac Surgery, Harefield Hospital, London, UK.
Journal of Cardiac Surgery
|September 13, 2022
Summary
Surgical trainees in cardiothoracic surgery can achieve outcomes comparable to fully trained surgeons when operating in high-volume centers. This study found no significant differences in key postoperative outcomes, demonstrating trainee safety and competence.
Area of Science:
- Cardiothoracic Surgery
- Surgical Education
- Patient Safety
Background:
- Assessing the safety and efficacy of surgical training is crucial for maintaining high standards in cardiothoracic surgery.
- Comparing outcomes between surgical trainees and experienced consultants is essential for evaluating training programs.
Purpose of the Study:
- To evaluate the safety of cardiothoracic surgery training by comparing patient outcomes between cases performed by trainees and fully trained surgeons.
Main Methods:
- A systematic literature search was conducted across EmBase, Scopus, PubMed, and OVID MEDLINE (August 2021).
- Inclusion criteria focused on cardiothoracic surgery studies reporting trainee outcomes; 27 studies (2 meta-analyses, 1 RCT, 24 cohort studies) met the criteria.
- Operative outcomes from 474,160 procedures performed by trainees (398,058) and consultants (75,943) were analyzed.
Main Results:
- No statistically significant differences were observed in preoperative risk scores between trainee and consultant cases.
- While cardiopulmonary bypass and clamp times for coronary artery bypass grafting (CABG) were similar, valve procedures took longer for trainees.
- Postoperative outcomes, including myocardial infarction, stroke, renal failure, and length of stay, showed no significant differences. In-hospital and midterm mortality rates were also comparable.
Conclusions:
- Surgical trainees can safely perform cardiothoracic procedures in high-volume units, achieving outcomes comparable to those of fully trained surgeons.
- The findings support the integration of trainees into dedicated, high-volume surgical centers to ensure quality patient care and effective surgical education.
