Is it safe to train residents to perform cardiac surgery?
BACKGROUND
The impact of surgical training on patient outcomes in cardiac surgery is unknown.


METHODS
All cases performed by residents from 1998 to 2001 were compared to staff surgeon cases using prospectively collected data. Operative mortality and a composite morbidity of: reoperation for bleeding perioperative myocardial infarction, infection, stroke, or ventilation more than 24 hours were compared using multivariate analysis.


RESULTS
Four residents performed 584 cases. The cases were as follows: coronary artery bypass grafting (CABG), 366 cases; aortic valve replacement (AVR) with or without CABG (AVR +/- CABG), 86 cases; mitral valve replacement, 31 cases; mitral valve repair, 25 cases; thoracic aneurysm/dissection, 22 cases; aortic root, 20 cases; transplantations, 14 cases; and adult congenital defect repairs, 20 cases. There were 2,638 CABGs and 363 AVR +/- CABG performed by the staff during the same period. Crude operative mortality in CABG patients was 2.5% (resident) and 2.9% (staff) (p = 0.62). In multivariate analysis, resident was not associated with operative mortality odds ratio (OR) of 0.59 (p = 0.19). Resident cases had a higher incidence of the composite morbidity outcome for CABG cases (19.4% vs 13.6% for staff; p = 0.003). However, in multivariate analysis, resident was not associated with increased morbidity (OR = 1.23, p = 0.16). The AVR +/- CABG crude mortality was 3.6% (resident) and 2.8% (staff) (p = 0.69). Because of the small number of cases (n = 447), operative mortality was combined with the composite morbidity outcome for the AVR +/- CABG model. In all, 16.7% of resident cases and 19.8% of staff cases had the composite outcome or died (p = 0.51). In multivariate analysis resident was not associated with this outcome (OR = 0.74, p = 0.35).


CONCLUSIONS
In this analysis of our experience with residency training, the operative morbidity and mortality in CABG and AVR patients was similar for residents and staff. Training residents to perform cardiac surgery appears to be safe.
Baskett
Roger J F
RJ
The Maritime Heart Centre, Dalhousie University, Halifax, Nova Scotia, Canada. rogerbaskett@hotmail.com
Buth
Karen J
KJ
Legaré
Jean-Francois
JF
Hassan
Ansar
A
Hancock Friesen
Camille
C
Hirsch
Gregory M
GM
Ross
David B
DB
Sullivan
John A
JA
D000328:Adult; D001018:Aortic Diseases / Q000601:surgery; D002170:Canada; D006348:Cardiac Surgical Procedures / Q000193:education* / Q000401:mortality; D001026:Coronary Artery Bypass; D006330:Heart Defects, Congenital; D006350:Heart Valve Prosthesis; D006351:Heart Valves / Q000601:surgery; D006801:Humans; D007396:Internship and Residency; D015999:Multivariate Analysis; D011446:Prospective Studies