Is Resident Training Safe in Cardiac Surgery?

Luthra, Suvitesh; Leiva‐Juárez, Miguel M.; Ismail, Abdelhadi; Tsang, Geoffrey; Barlow, Clifford W.; Velissaris, Theodore; Ohri, Sunil K.

doi:10.1016/j.athoracsur.2020.02.009

Cited by 14 publications

(14 citation statements)

References 18 publications

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“…After PSM, the 30-day mortality and the incidence of postoperative complications were not significantly different between the 2 groups. Similarly, in the study by Luthra et al [ 10 ], the perioperative outcomes of 639 patients operated on by trainees were comparable with the results achieved by consultants. It was not possible to find any study supporting the evidence that trainees acting as first operators were associated with worse outcomes.…”

Section: Discussionsupporting

confidence: 63%

The impact of surgical training on early and long-term outcomes after isolated aortic valve surgery

Dimagli

Sinha

Benedetto

et al. 2021

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES Patients presenting with more comorbidities, requiring more complex cardiac surgical procedures and an increase in public scrutiny are impacting on training programme because of the perceived risk of worse outcomes. Hence, we aimed to provide evidence that trainees as the first operator can achieve comparable results to consultants when performing isolated surgical aortic valve replacement. METHODS From 1996 to 2017, 2919 patients underwent surgical aortic valve replacement at the Bristol Heart Institute, operated on by either a consultant (n = 2220) or a trainee (n = 870) as the first operator. Propensity score matching was used to adjust for imbalance in the baseline characteristics of the 2 groups. RESULTS Over a 21-year period, the proportion of trainee cases dropped from 41.5% to 25.9%. No differences in the rates and risk of in-hospital mortality, new cerebrovascular accidents, re-exploration for bleeding, deep sternal wound infection and length of stay were found between patients operated on in the 2 groups. Also, there was a comparable risk of late death between the 2 groups (HR 0.88; 95% CI 0.73–1.06; P = 0.27) and this was present regardless of trainees career level and patients surgical risk based on the EuroSCORE. Finally, we showed an increase in patients risk profile in the latest year but, this was not associated with the worst outcomes when trainees performed the operation. CONCLUSIONS Surgical aortic valve replacement is a safe and reproducible technique and regardless of the patient’s risk profile, and no differences in the outcomes between trainees and consultant cases were found.

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Section: Discussionsupporting

confidence: 63%

The impact of surgical training on early and long-term outcomes after isolated aortic valve surgery

Dimagli

Sinha

Benedetto

et al. 2021

European Journal of Cardio-Thoracic Surgery

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“…It should also be considered that private payers are operated on only by the responsible consultant surgeon and anaesthetist and they are not considered for training sessions. However, previous studies did not show any association between cases performed by trainees and increased risk of hospital mortality [16] .…”

Section: Discussionmentioning

confidence: 74%

Disparity in clinical outcomes after cardiac surgery between private and public (NHS) payers in England

Benedetto

Dimagli

Gibbison

et al. 2021

The Lancet Regional Health - Europe

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Background There is little known about how payer status impacts clinical outcomes in a universal single-payer system such as the UK National Health Service (NHS). The aim of this study was to evaluate the relationship between payer status (private or public) and clinical outcomes following cardiac surgery from NHS providers in England. Methods The National Adult Cardiac Surgery Audit (NACSA) registry was interrogated for patients who underwent adult cardiac surgery in England from 2009 to 2018. Information on socioeconomic status were provided by linkage with the Iteration of the English Indices of Deprivation (IoD). The primary outcome was in-hospital mortality. Secondary outcomes included incidence of in-hospital postoperative cerebrovascular accident (CVA), renal dialysis, sternal wound infection, and re-exploration. To assess whether payer status was an independent predictor of in-hospital mortality, binomial generalized linear mixed models (GLMM) were fitted along with 17 items forming the EuroSCORE and the IoD domains. Findings The final sample consisted of 280,209 patients who underwent surgery in 31 NHS hospitals in England from 2009 to 2018. Of them, 5,967 (2.1%) and 274,242 (97.9%) were private and NHS payers respectively. Private payer status was associated with a lower risk of in-hospital mortality (OR 0.79; 95%CI 0.65 – 0.97; P = 0.026), CVA (OR 0.77; 95%CI 0.60 – 0.99; P = 0.039), need for re-exploration (OR 0.84; 95%CI 0.72 – 0.97; P = 0.017) and with non-significant lower risk of dialysis (OR 0.84; 95%CI 0.69 – 1.02; P = 0.074). Private payer status was found to be independently associated with lower risk of in-hospital mortality in the elective subgroup (OR 0.76; 95%CI 0.61 – 0.96; P = 0.020) but not in the non-elective subgroup (OR 1.01; 95%CI 0.64 – 1.58; P = 0.976). Interpretation In conclusion, using a national database, we have found evidence of significant beneficial effect of payer status on hospital outcomes following cardiac surgery in favour of private payers regardless their socioeconomic factors.

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“…In essence, with their data the authors have added more evidence to the notion that supervised resident physician autonomy in the operating room does not translate to worse outcomes. 2,3 The results are also encouraging because they indicate that current and previous resident physicians have been able to safely operate under supervision. From this standpoint, longer CPB and ACX times likely represent surrogates of safety, implying that resident physicians are not being rushed to complete their tasks by potentially compromising on quality.…”

mentioning

confidence: 83%

“…Training cases could then be incorporated separately into the payment model, thus removing some barriers to better training of physicians during residency. 3 Training in cardiothoracic surgery is complex due to the technical nature of the procedures, the different training pathways, and the length and intensity of training. 6 What's at stake here is patient welfare-be it today with good surgeons, or tomorrow with well or poorly trained ones.…”

mentioning

confidence: 99%