| Is it safe to train residents to perform cardiac surgery? | |
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MedLine Citation:
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PMID: 12400743 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The impact of surgical training on patient outcomes in cardiac surgery is unknown. METHODS: All cases performed by residents from 1998 to 2001 were compared to staff surgeon cases using prospectively collected data. Operative mortality and a composite morbidity of: reoperation for bleeding perioperative myocardial infarction, infection, stroke, or ventilation more than 24 hours were compared using multivariate analysis. RESULTS: Four residents performed 584 cases. The cases were as follows: coronary artery bypass grafting (CABG), 366 cases; aortic valve replacement (AVR) with or without CABG (AVR +/- CABG), 86 cases; mitral valve replacement, 31 cases; mitral valve repair, 25 cases; thoracic aneurysm/dissection, 22 cases; aortic root, 20 cases; transplantations, 14 cases; and adult congenital defect repairs, 20 cases. There were 2,638 CABGs and 363 AVR +/- CABG performed by the staff during the same period. Crude operative mortality in CABG patients was 2.5% (resident) and 2.9% (staff) (p = 0.62). In multivariate analysis, resident was not associated with operative mortality odds ratio (OR) of 0.59 (p = 0.19). Resident cases had a higher incidence of the composite morbidity outcome for CABG cases (19.4% vs 13.6% for staff; p = 0.003). However, in multivariate analysis, resident was not associated with increased morbidity (OR = 1.23, p = 0.16). The AVR +/- CABG crude mortality was 3.6% (resident) and 2.8% (staff) (p = 0.69). Because of the small number of cases (n = 447), operative mortality was combined with the composite morbidity outcome for the AVR +/- CABG model. In all, 16.7% of resident cases and 19.8% of staff cases had the composite outcome or died (p = 0.51). In multivariate analysis resident was not associated with this outcome (OR = 0.74, p = 0.35). CONCLUSIONS: In this analysis of our experience with residency training, the operative morbidity and mortality in CABG and AVR patients was similar for residents and staff. Training residents to perform cardiac surgery appears to be safe. |
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Authors:
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Roger J F Baskett; Karen J Buth; Jean-Francois Legaré; Ansar Hassan; Camille Hancock Friesen; Gregory M Hirsch; David B Ross; John A Sullivan |
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Publication Detail:
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Type: Comparative Study; Journal Article |
Journal Detail:
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Title: The Annals of thoracic surgery Volume: 74 ISSN: 0003-4975 ISO Abbreviation: Ann. Thorac. Surg. Publication Date: 2002 Oct |
Date Detail:
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Created Date: 2002-10-28 Completed Date: 2002-11-26 Revised Date: 2007-02-22 |
Medline Journal Info:
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Nlm Unique ID: 15030100R Medline TA: Ann Thorac Surg Country: United States |
Other Details:
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Languages: eng Pagination: 1043-8; discussion 1048-9 Citation Subset: AIM; IM |
Affiliation:
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The Maritime Heart Centre, Dalhousie University, Halifax, Nova Scotia, Canada. rogerbaskett@hotmail.com |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aortic Diseases / surgery Canada Cardiac Surgical Procedures / education*, mortality Coronary Artery Bypass Heart Defects, Congenital Heart Valve Prosthesis Heart Valves / surgery Humans Internship and Residency* Multivariate Analysis Prospective Studies |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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