Related Experiment Video
Updated: May 31, 2025
An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function
Published on: April 17, 2020
Association Between Cardiothoracic Fellows and Clinical and Financial Outcomes in Coronary Surgery
Brandon Peine1, Hanna Long2, J Preston Bethea3
1Division of Cardiac Surgery, Department of Cardiovascular Sciences, East Carolina University, Greenville, North Carolina.
Insights
Cardiothoracic surgery fellows participating in coronary artery bypass grafting (CABG) procedures do not negatively impact clinical outcomes. While operative times and costs slightly increase, patient safety and reimbursement remain unaffected, supporting continued fellow training.
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.
Introduction:
Mounting financial pressures on academic institutions highlight the need to understand the effect on outcomes from trainee involvement in cardiac surgery. The purpose of this study is to examine the association between cardiothoracic fellows and clinical and financial outcomes in coronary artery bypass grafting (CABG).
Methods:
Data for all patients from 2017 to 2022 at a single institution who underwent nonemergent, isolated, open CABG were included in the study, with patients grouped by whether there was fellow operative participation. Financial and clinical outcomes were compared between the two groups using multivariable regression and generalized estimating equations to control for variation in patient characteristics and attending cardiac surgeon practices.
Results:
A total of 1997 patients met criteria for study inclusion, with 632 (31.5%) cases that had fellow participation and 1365 (68.4%) that did not. Patients in the fellow participation group had a 0.8% higher median preoperative risk score than those that did not have fellow participation. Fellow participation was associated with significantly longer total case length (61 mins) but no differences in postoperative clinical outcomes. There was an increased median total hospitalization cost of approximately $2200 in cases with fellow participation, likely attributable to increased intraoperative costs from longer case times.
Conclusions:
While CT surgery fellow participation was associated with longer operative times and a small increase in hospitalization cost in CABG, there were no significant differences in clinical outcomes. Continuing to train cardiothoracic surgery fellows in this procedure is safe and would not be expected to significantly impact reimbursement under bundled payment models.
More Related Videos
08:50Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
08:49Author Spotlight: Enhancing Graft Viability Assessment Through Quantitative Metrics and Innovative Reservoir Systems
Published on: August 2, 2024
