Association Between Cardiothoracic Fellows and Clinical and Financial Outcomes in Coronary Surgery

Area of Science:

• Cardiovascular Surgery
• Surgical Education
• Health Economics

Background:

• Academic institutions face financial pressures impacting trainee involvement in cardiac surgery.
• Understanding the clinical and financial outcomes of cardiothoracic (CT) fellow participation in coronary artery bypass grafting (CABG) is crucial.

Purpose of the Study:

• To examine the association between CT fellow involvement and clinical and financial outcomes in isolated, open CABG procedures.
• To assess the safety and economic implications of training fellows in CABG surgery.

Main Methods:

• Retrospective analysis of 1997 nonemergent, isolated, open CABG cases (2017-2022) at a single institution.
• Patients were grouped based on the presence or absence of fellow operative participation.
• Multivariable regression and generalized estimating equations controlled for patient and surgeon variations.

Main Results:

• Fellow participation occurred in 31.5% of cases and was associated with a slightly higher preoperative risk score.
• Fellow involvement correlated with longer total case length (61 minutes) but no significant differences in postoperative clinical outcomes.
• Hospitalization costs increased by approximately $2200, attributed to longer intraoperative times.

Conclusions:

• CT surgery fellow participation in CABG is safe, with no adverse impact on clinical outcomes.
• While operative times and costs show a modest increase, these are not expected to significantly affect reimbursement under bundled payment models.
• Continued training of CT surgery fellows in CABG is supported by these findings.