Long-term results of heart operations performed by surgeons-in-training.
BACKGROUND
We investigated the association between trainees performing supervised operations and late outcomes of patients undergoing cardiac surgery.


RESULTS
Data were prospectively collected on patients who underwent coronary artery bypass graft surgery, aortic valve replacement, or a combination of these between 1998 and 2005 at the Maritime Heart Center, Halifax, Canada. In-hospital mortality and a composite outcome of in-hospital mortality, stroke, bleeding, intra-aortic balloon pump insertion, renal failure, and sternal infection was compared between teaching (n=1054) and nonteaching cases (n=5877). Late survival and cardiovascular hospital readmissions were also examined. To adjust for baseline risk disparities, we used logistic regression for dichotomous in-hospital outcomes and Cox proportional hazards regression for survival data. Resident cases were significantly more likely to have high-risk features such as depressed ventricular function, redo operation, and urgent or emergent procedure. Resident as primary operator was not independently associated with in-hospital mortality (OR, 1.09; 95% CI, 0.75 to 1.58; P=0.66) or with the composite outcome (OR, 1.01; 95%, CI 0.82 to 1.26; P=0.90). The Kaplan-Meier event-free survival of the 2 groups was equivalent at 1, 3, and 5 years (log-rank P=0.06). By Cox regression, resident cases were not associated with late death or cardiovascular rehospitalization (hazard ratio, 1.05; 95% CI, 0.94 to 1.17; P=0.42).


CONCLUSIONS
Cases performed by senior-level cardiac surgery residents were more likely to have greater acuity and complexity than staff surgeon-performed cases. However, clinical outcomes were similar in the short- and long-term. Allowing residents to perform cardiac surgery is not associated with adverse patient outcomes.
Stoica
Serban C
SC
Queen Elizabeth II Health Sciences Centre, 1796 Summer Street, Room 2269, Halifax, Nova Scotia, Canada. rogerbaskett@hotmail.com
Kalavrouziotis
Dimitri
D
Martin
Billie-Jean
BJ
Buth
Karen J
KJ
Hirsch
Gregory M
GM
Sullivan
John A
JA
Baskett
Roger J F
RJ
D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve; D006348:Cardiac Surgical Procedures; D001026:Coronary Artery Bypass; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D017052:Hospital Mortality; D006801:Humans; D007396:Internship and Residency; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008505:Medical Staff, Hospital; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome