Medium-term results of systematic off-pump coronary surgery performed by trainee surgeons☆

Messina, Antonio; Villa, Emmanuel; Mhagna, Zen; Tomba, Margherita Dalla; Cirillo, Marco; Brunelli, Federico; Quaini, Eugenio; Troise, Giovanni

doi:10.1016/j.ejcts.2010.02.029

Cited by 16 publications

(8 citation statements)

References 24 publications

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“…Sixteen studies highlight the need for supervision by showing similar patient outcomes for supervised residents [52,54,56-58,68,73,75,76,79,80,85,86,90,94] or worse patient outcomes for unsupervised residents [60,84]. Many studies compared faculty with residents in small settings with small sample sizes.…”

Section: Resultsmentioning

confidence: 99%

A systematic review of the effects of residency training on patient outcomes

Leeuw

Lombarts

Arah

et al. 2012

BMC Med

138

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BackgroundResidents are vital to the clinical workforce of today and tomorrow. Although in training to become specialists, they also provide much of the daily patient care. Residency training aims to prepare residents to provide a high quality of care. It is essential to assess the patient outcome aspects of residency training, to evaluate the effect or impact of global investments made in training programs. Therefore, we conducted a systematic review to evaluate the effects of relevant aspects of residency training on patient outcomes.MethodsThe literature was searched from December 2004 to February 2011 using MEDLINE, Cochrane, Embase and the Education Resources Information Center databases with terms related to residency training and (post) graduate medical education and patient outcomes, including mortality, morbidity, complications, length of stay and patient satisfaction. Included studies evaluated the impact of residency training on patient outcomes.ResultsNinety-seven articles were included from 182 full-text articles of the initial 2,001 hits. All studies were of average or good quality and the majority had an observational study design. Ninety-six studies provided insight into the effect of 'the level of experience of residents' on patient outcomes during residency training. Within these studies, the start of the academic year was not without risk (five out of 19 studies), but individual progression of residents (seven studies) as well as progression through residency training (nine out of 10 studies) had a positive effect on patient outcomes. Compared with faculty, residents' care resulted mostly in similar patient outcomes when dedicated supervision and additional operation time were arranged for (34 out of 43 studies). After new, modified or improved training programs, patient outcomes remained unchanged or improved (16 out of 17 studies). Only one study focused on physicians' prior training site when assessing the quality of patient care. In this study, training programs were ranked by complication rates of their graduates, thus linking patient outcomes back to where physicians were trained.ConclusionsThe majority of studies included in this systematic review drew attention to the fact that patient care appears safe and of equal quality when delivered by residents. A minority of results pointed to some negative patient outcomes from the involvement of residents. Adequate supervision, room for extra operation time, and evaluation of and attention to the individual competence of residents throughout residency training could positively serve patient outcomes. Limited evidence is available on the effect of residency training on later practice. Both qualitative and quantitative research designs are needed to clarify which aspects of residency training best prepare doctors to deliver high quality care.

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Section: Resultsmentioning

confidence: 99%

A systematic review of the effects of residency training on patient outcomes

Leeuw

Lombarts

Arah

et al. 2012

BMC Med

138

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“…These findings are consistent with previous studies and add to the body of evidence that exposing trainees to off-pump techniques is safe and reproducible. 12,13 Previous studies comparing outcomes between consultant and trainee surgeons have been limited, to some degree, by the tendency of consultant surgeons to select the more complex and higher risk cases. In this series, however, the baseline characteristics of the trainee and consultant surgeon groups were similar with comparable Euroscore and number of grafts performed.…”

Section: Discussionmentioning

confidence: 99%

Establishing the Safety of Training in Off-Pump Coronary Artery Bypass Surgery: A Retrospective Comparison of Outcomes between Trainees and a Consultant Surgeon

Pal

Hartley

Salmasi

et al. 2020

Thorac Cardiovasc Surg

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Background The safety of training in off-pump coronary artery bypass (OPCAB) surgery and the stage at which trainees should be exposed to this technique remain controversial. This single-center retrospective study aimed to compare outcomes of OPCAB surgery in consultant and trainee cases. Methods Between 2014 and 2018, all isolated OPCAB operations performed under the care of a consultant surgeon (G.A.) were analyzed. Cases where a surgeon below consultant grade performed at least 70% of the distal anastomoses were designated as “trainee cases” with the remaining cases designated as “consultant cases.” The baseline characteristics of patients, perioperative data, and short-term outcomes were prospectively collated and analyzed. Results During the study period, 245 OPCAB cases were identified: 142 (58%) consultant and 103 (42%) trainee cases. The trainee cases were performed exclusively by trainees in the final 2 years of the UK National Cardiothoracic Training Program. Both trainee and consultant groups had low mortality with two perioperative deaths occurring in either group. The rates of serious postoperative complications including stroke (n = 1 vs. 2, p = 0.759), resternotomy for bleeding (n = 3 vs. 7, p = 0.431), and mediastinal infection (n = 2 vs. 3, p = 0.926) were low and not significantly different between the two groups. Patients operated on by trainees had a slightly longer hospital stay than those operated on by the consultant surgeon, although this did not reach statistical significance (9.9 vs. 7.9 days). Conclusions These results demonstrate comparable outcomes in OPCAB surgery between a consultant surgeon and trainees. This study supports the conclusion that training surgeons in OPCAB is appropriate for trainees in the final years of cardiac surgery training.

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“…The teaching of OPCAB [42] must provide an approach to both prevention and management of conversion. In essence, this involves attention to best-practice concepts in OPCAB: patient selection, an understanding of cardiac-positioning devices, ideal grafting sequences and precipitants of haemodynamic instability, such as manipulation, ischaemia during anastomoses, arrhythmias and anaesthesiological factors [43].…”

Section: Training and Learning Curve Issuesmentioning

confidence: 99%

Intra-operative conversion is a cause of masked mortality in off-pump coronary artery bypass: a meta-analysis

Mukherjee

Ashrafian

Kourliouros

et al. 2012

European Journal of Cardio-Thoracic Surgery

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Coronary artery bypass surgery can offer excellent results when performed with cardiopulmonary bypass (on pump) or without cardiopulmonary bypass (off pump). The debate as to which technique is superior remains unanswered. Intra-operative conversion from off- to on-pump coronary surgery is a relatively unexplored phenomenon, which cannot be assessed within randomised controlled trial design. We aimed to assess the effect of off-pump conversion on patient mortality. Medline, Embase, Cochrane and Google Scholar databases were systematically reviewed for studies published between 1980 and 2010 that compared the incidence of mortality between converted and non-converted off-pump patients. Publication bias and heterogeneity were assessed and data were extracted independently by multiple observers. We undertook a meta-analysis of these studies using random effects modelling. A total of 17 studies fulfilled our inclusion criteria, containing data for 18,870 off-pump coronary artery bypass operations spanning a decade (1998-2008), involving 920 cases of conversion. Overall, conversion increased mortality by an odds ratio of 6.18 (95% confidence interval 4.65-8.20), whereas emergency conversion further raised the odds ratio of mortality to 6.99 (95% confidence interval 5.18-9.45). The conversion from off- to on-pump cardiac surgery may significantly increase the chance of an adverse outcome, whereas emergency conversion confers a significant rise in mortality. The risk of conversion should be discussed when obtaining the patient's informed consent and its prevention warrants serious consideration by cardiac surgeons and cardiac surgical training programmes.

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Medium-term results of systematic off-pump coronary surgery performed by trainee surgeons☆

Cited by 16 publications

References 24 publications

A systematic review of the effects of residency training on patient outcomes

A systematic review of the effects of residency training on patient outcomes

Establishing the Safety of Training in Off-Pump Coronary Artery Bypass Surgery: A Retrospective Comparison of Outcomes between Trainees and a Consultant Surgeon

Intra-operative conversion is a cause of masked mortality in off-pump coronary artery bypass: a meta-analysis

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