Impact of cardiothoracic resident turnover on mortality after cardiac surgery: a dynamic human factor.
BACKGROUND
The study was designed to determine whether cardiac surgical outcomes are affected during times of major turnover of cardiothoracic resident surgical staff and at the beginning versus the end of their training periods.


METHODS
This observational cohort study analyzed data from cardiac operations between April 1996 and March 2006 at a single institution. In-hospital mortality and other outcomes were compared between operations done during months of major change in resident staff rotation (July, August, January, February, n = 5,517) and the rest of the year (n = 10,773). We also compared outcomes at the beginning and end of surgical rotation for cardiothoracic residents. Adjustment was made for EuroSCORE (European System for Cardiac Operative Risk Evaluation), year of operation, and surgeon resident status. Analyses were done within surgery procedure subgroups of isolated coronary artery bypass graft surgery (CABG) and complex operations (CABG combined with other procedures).


RESULTS
Patient populations in the groups were similar. After risk adjustment, there was a significant increase in hospital mortality for the complex cases during months of resident staff change compared with rest of the year (odds ratio 1.3, 95% confidence interval: 1.3, 1.4; p = 0.02). There was, however, no significant difference in mortality for the CABG only cases (odds ratio 1.1, 95% confidence interval: 0.8, 1.4; p = 0.61). Risk-adjusted mortality after operations done by residents was the same at the start and finish of their surgical rotation. During the change months, the surgery time was 2.2 minutes longer on average in CABG operations (95% confidence interval: 0.3, 4.0; p = 0.02), and no different in combined cases.


CONCLUSIONS
Periods of major change in resident surgical staff are associated with increased risk-adjusted in-hospital mortality after complex cardiac operations but not after CABG alone.
Papworth Hospital NHS Trust and MRC Biostatistics Unit, Institute of Public Health, Cambridge University, Cambridge, United Kingdom. jeffrey01@mac.com
Jeffrey H
JH
Shuhaiber
Kimberley
K
Goldsmith
Samer A M
SA
Nashef
D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods / Q000401:mortality*; D002423:Cause of Death; D001026:Coronary Artery Bypass / Q000379:methods / Q000401:mortality; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010563:Personnel Turnover / Q000706:statistics & numerical data*; D011336:Probability; D011787:Quality of Health Care; D018570:Risk Assessment; D012308:Risk Management; D016019:Survival Analysis; D006113:United Kingdom