Comparison of the first 100 coronary bypass patients of a supervised resident with his first 100 as an attending surgeon at the same institution.
BACKGROUND
Although coronary artery bypass grafting (CABG) has been analyzed intensely for 30 years, little information is available on the characteristics and outcome of CABG patients operated upon by resident trainees or first-year attending surgeons in a public teaching hospital.


METHODS
The first 100 CABG patients operated upon by a supervised resident were compared with the first 100 CABG patients under the care of the same person as an attending surgeon at the same institution. In the first group, the resident was directly supervised by one of three different staff surgeons. In the second group, the same person, as an attending, performed 60 operations and directly supervised one of two trainees in 40.


RESULTS
Comparing the resident group versus the attending group, mean age (62 versus 61 years), percentage of females (37 and 37), tobacco use (74 versus 77), obesity (43 versus 55), insulin-dependent diabetes mellitus (20 versus 17), ejection fraction < or =0.5 (29 versus 35), and previous myocardial infarction (56 versus 54) were similar. Three or more coronary anastomoses were performed in 83 patients in the first group and in 74 in the second group. Early mortality (in-hospital and/or < or =30 days) occurred in 2 patients in the resident group and 3 in the attending group; each patient had a low ejection fraction and severe narrowing of all three major epicardial coronary arteries. Morbidity in the two groups was similar.


CONCLUSIONS
If properly supervised by experienced staff surgeons, a resident trainee can achieve satisfactory results in CABG in a heterogeneous group of patients. Furthermore, the transition to attending surgeon can be achieved with a good outcome for the patients.
Roberts
C S
CS
Division of Cardiothoracic Surgery, University of North Carolina School of Medicine, Chapel Hill, USA.
Bocanegra
N R
NR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002309:Cardiology / Q000193:education*; D002983:Clinical Competence; D001026:Coronary Artery Bypass / Q000379:methods; D006801:Humans; D007396:Internship and Residency; D008505:Medical Staff, Hospital; D008875:Middle Aged; D016896:Treatment Outcome