title: Outcomes of Trainees Performing Coronary Artery Bypass Grafting: Does Resident Experience Matter?
abstract: BACKGROUND
  Outcomes after coronary artery bypass graft surgery (CABG) are known to be dependent on attending surgeon volume, but the impact of resident experience is unknown. Our objective was to assess the influence of resident experience to understand the learning curve for CABG.
  
  
  METHODS
  From 2008 to 2014, all isolated on-pump CABG (n = 1,668) during which a resident performed the entire operation (including sternotomy, mammary artery harvest, coronary anastomoses, and closure) were reviewed. Operations were stratified by individual resident CABG experience. Primary outcomes included operative time, which was further divided into "opening time" (incision to bypass initiation), cardiopulmonary bypass times, cross-clamp times, and "closing times" (bypass termination to close). Secondary outcomes included 30-day mortality and major complications.
  
  
  RESULTS
  Operative time was 29.7 minutes longer (p < 0.001) during residents' first 30 CABG, primarily driven by longer opening and closing times. After controlling for resident, attending physician, preoperative risk, number of grafts, and redo status, the completion of 30 operations improved operative time by 25 minutes (p < 0.001), the majority of which included opening time (13 minutes, p < 0.001). Minor differences in bypass and cross-clamp times were not clinically meaningful, and there were no differences in 30-day mortality or major complications with respect to resident experience.
  
  
  CONCLUSIONS
  Total operative time during CABG is dependent on resident experience, with significant improvement by approximately the 30th case. Importantly, these differences do not translate into worse outcomes. These data support trainees performing all components of CABG-even early in the residency experience.
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia. Electronic address: kenan@virginia.edu.
authors.forename: Kenan W
authors.initials: KW
authors.lastname: Yount
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia.
authors.forename: Leora T
authors.initials: LT
authors.lastname: Yarboro
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia.
authors.forename: Adishesh K
authors.initials: AK
authors.lastname: Narahari
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia.
authors.forename: Ravi K
authors.initials: RK
authors.lastname: Ghanta
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia.
authors.forename: Curtis G
authors.initials: CG
authors.lastname: Tribble
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia.
authors.forename: Irving L
authors.initials: IL
authors.lastname: Kron
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia.
authors.forename: John A
authors.initials: JA
authors.lastname: Kern
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia.
authors.forename: Gorav
authors.initials: G
authors.lastname: Ailawadi
mesh_terms: D000328:Adult; D000368:Aged; D002983:Clinical Competence; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000193:education* / Q000401:mortality; D003324:Coronary Artery Disease / Q000150:complications / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D007396:Internship and Residency; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D016896:Treatment Outcome