title: Resident versus attending surgeon graft patency and clinical outcomes in on- versus off-pump coronary artery bypass surgery.
abstract: OBJECTIVE
  Controversy exists regarding ideal approaches in teaching residents complex and/or new surgical techniques in part because consequences on patient outcomes are largely unknown. This study compared patient outcomes for cases in which residents (rather than attending surgeons) performed most of the distal anastomoses as primary surgeons, during on- and off-pump coronary artery bypass grafting (CABG).
  
  
  METHODS
  This preapproved substudy of the Randomized On/Off Bypass (ROOBY) trial compared clinical outcomes and 1-year graft patency for cases in which residents versus attending surgeons were the primary operator. Comparisons were made between on-pump and off-pump techniques.
  
  
  RESULTS
  From July 2003 through May 2007, a total of 1272 ROOBY nonemergent CABG patients were randomized at 16 Veterans Affairs centers where residents were active participants. Residents were the primary surgeon (ie, performed ≥50% of the distal anastomoses) more frequently in on-pump (77.9%) than in off-pump (67.4%) cases. Between these 2 techniques, no differences were found [corrected] in baseline patient characteristics; short-term and 1-year morbidity and mortality rates were no different for residents versus attendings in CABG cases. FitzGibbon A graft patency rates were similar for resident versus attendings completed distal anastomoses for on-pump (83.0% vs 82.4%) compared with off-pump (77.2% vs 76.6%) procedures.
  
  
  CONCLUSIONS
  In the ROOBY trial, short-term and 1-year patient outcomes and graft patency rates did not differ between resident and attending surgeons, demonstrating that with appropriate patient selection and resident supervision, residents can perform advanced, novel surgical techniques with outcomes similar to those of attending surgeons.
authors.affiliation: Department of Cardiothoracic Surgery, Medical College of Wisconsin and Veterans Affairs Medical Center, Milwaukee, Wis. Electronic address: halmassi@mcw.edu.
authors.forename: G Hossein
authors.initials: GH
authors.lastname: Almassi
authors.affiliation: Department of Surgery, Northport Veterans Affairs Medical Center and Stony Brook School of Medicine, Stony Brook, NY.
authors.forename: Brendan M
authors.initials: BM
authors.lastname: Carr
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Muath
authors.initials: M
authors.lastname: Bishawi
authors.affiliation: Department of Surgery, Northport Veterans Affairs Medical Center and Stony Brook School of Medicine, Stony Brook, NY.
authors.forename: A Laurie
authors.initials: AL
authors.lastname: Shroyer
authors.affiliation: Department of Cardiac Surgery, Veterans Affairs Boston Healthcare System, West Roxbury, Mass.
authors.forename: Jacquelyn A
authors.initials: JA
authors.lastname: Quin
authors.affiliation: Department of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver, and University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, Colo.
authors.forename: Brack
authors.initials: B
authors.lastname: Hattler
authors.affiliation: Veterans Affairs Palo Alto Health Economics Resource Center, Menlo Park, Calif, and Department of Health Research and Policy, Stanford University, Stanford, Calif.
authors.forename: Todd H
authors.initials: TH
authors.lastname: Wagner
authors.affiliation: Cooperative Studies Program Coordinating Center and Veterans Affairs Medical Center, Perry Point, Md.
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Collins
authors.affiliation: Department of Surgery, Portland Veterans Affairs Medical Center and Oregon Health Sciences University, Portland, Ore.
authors.forename: Pasala
authors.initials: P
authors.lastname: Ravichandran
authors.affiliation: Department of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver, and University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, Colo.
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Cleveland
authors.affiliation: Department of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver, and University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, Colo.
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Grover
authors.affiliation: Cardiothoracic Surgery, Baylor College of Medicine and Houston Veterans Affairs Medical Center, Houston, Tex.
authors.forename: Faisal G
authors.initials: FG
authors.lastname: Bakaeen
mesh_terms: D001026:Coronary Artery Bypass; D047549:Coronary Artery Bypass, Off-Pump; D006801:Humans; D007396:Internship and Residency; D008505:Medical Staff, Hospital; D016896:Treatment Outcome; D014654:Vascular Patency
keywords: CABG; education; graft patency; off-pump; on-pump; resident training