title: Equivalent outcomes after coronary artery bypass graft surgery performed by consultant versus trainee surgeons: A systematic review and meta-analysis.
abstract: OBJECTIVE
  In recent years, concerns have been raised about the learning opportunities available to cardiac surgical trainees. This meta-analysis was conducted to assess the impact of trainee operator status on clinical outcomes after coronary artery bypass graft (CABG) surgery.
  
  
  METHODS
  Medline, EMBASE, and the Cochrane Library were systematically searched for studies that reported CABG outcomes according to the training status of the primary operator (consultant vs trainee). Data were independently extracted by 2 investigators; a meta-analysis was conducted according to predefined clinical endpoints.
  
  
  RESULTS
  Sixteen observational studies (n = 52,966) met criteria for inclusion, with 8 studies (n = 36,479) reporting propensity-adjusted analyses. Trainee cases were associated with increased aortic crossclamp duration (mean difference: 4.80; 95% confidence interval [CI], 0.76-8.83) and cardiopulmonary bypass duration (mean difference: 4.24; 95% CI, 0.00-8.47). Perioperative mortality was similar for CABG performed primarily by trainees versus consultants (odds ratio 0.98; 95% CI, 0.81-1.18). No significant difference was found in the incidence of perioperative stroke, myocardial infarction, acute renal failure, reoperation for bleeding, or wound infection. Trainee operator status was not associated with increased midterm mortality (hazard ratio 1.00; 95% CI, 0.90-1.11). In subgroup analysis that included 5 studies and 8025 patients, off-pump CABG trainee cases were not associated with increased perioperative mortality or morbidity.
  
  
  CONCLUSIONS
  With appropriate supervision, conventional CABG can be performed by trainee surgeons without an adverse impact on perioperative outcomes or midterm survival. Data regarding off-pump CABG are limited, and further research is warranted to ascertain the impact of trainee operator status on long-term outcomes after off-pump CABG.
authors.affiliation: South Western Sydney Clinical School, University of New South Wales, Sydney, Australia. Electronic address: sohaib.211@gmail.com.
authors.forename: Sohaib A
authors.initials: SA
authors.lastname: Virk
authors.affiliation: Melbourne Medical School, University of Melbourne, Melbourne, Australia.
authors.forename: Sebastian R A
authors.initials: SRA
authors.lastname: Bowman
authors.affiliation: Department of Cardiothoracic Surgery, Liverpool Hospital, Sydney, Australia.
authors.forename: Lionel
authors.initials: L
authors.lastname: Chan
authors.affiliation: Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia; Discipline of Surgery, Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: Paul G
authors.initials: PG
authors.lastname: Bannon
authors.affiliation: Department of Cardiothoracic Surgery, Liverpool Hospital, Sydney, Australia.
authors.forename: Waleed
authors.initials: W
authors.lastname: Aty
authors.affiliation: Department of Cardiothoracic Surgery, Liverpool Hospital, Sydney, Australia.
authors.forename: Bruce G
authors.initials: BG
authors.lastname: French
authors.affiliation: Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia; Discipline of Surgery, Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: Akshat
authors.initials: A
authors.lastname: Saxena
mesh_terms: D016009:Chi-Square Distribution; D002983:Clinical Competence; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000193:education* / Q000401:mortality; D047549:Coronary Artery Bypass, Off-Pump / Q000193:education; D004503:Education, Medical, Graduate; D006801:Humans; D016017:Odds Ratio; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
keywords: coronary artery bypass graft; meta-analysis; surgical education; surgical training; trainee outcomes