Training residents in off-pump coronary artery bypass surgery: A 14-year experience

Murzi, Michele; Caputo, Massimo; Aresu, Giuseppe; Duggan, Seána; Angelini, Gianni

doi:10.1016/j.jtcvs.2011.09.049

Cited by 39 publications

(18 citation statements)

References 21 publications

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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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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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“…[5][6][7] Although some of these studies have looked at specific types of operations such as off-pump revascularization or have documented the progress of resident learning as demonstrated by a decrease in the time it takes a trainee to perform a certain task, none of them have routinely provided robust data about the degree of trainee independence. [8][9][10] The majority of these studies do not comment on attending/ resident overlap and have not systematically examined many preoperative, perioperative, and postoperative parameters. [11][12][13] The purpose of this study was to compare postoperative outcomes of 2 similar surgical patient cohorts whose operations were performed entirely by an attending surgeon or by a physician in training.…”

Section: See Editorial Commentary Page 2066mentioning

confidence: 99%

Teaching operative cardiac surgery in the era of increasing patient complexity: Can it still be done?

Tolis

Spencer

Bloom

et al. 2018

The Journal of Thoracic and Cardiovascular Surgery

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“…Performing MAG is undoubtedly technically demanding and patient's safety should always be a concern when training young surgeons. The effect of training on clinical outcome after cardiac surgery has been the subject of previous publications [14][15][16][17]. However, to the best of our knowledge, this is the first study which compared outcomes in patients undergoing CABG with MAG performed by residents versus attending surgeons and we found that the two groups had comparable short term outcomes and long term survival.…”

Section: Discussionmentioning

confidence: 66%

How Safe Is it to Train Residents to Perform Coronary Surgery With Multiple Arterial Grafting? Nineteen Years of Training at a Single Institution

Benedetto

Caputo

Gaudino

et al. 2017

Seminars in Thoracic and Cardiovascular Surgery

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The learning curve of coronary artery bypass grafting (CABG) with multiple arterial grafting (MAG) is perceived to be associated with increased surgical morbidity and potentially poorer long-term outcomes. We compared short-term outcomes and long-term survival in patients who underwent CABG with MAG performed by attending surgeons or resident trainees at a single institution over a period of 19 years. Using our institutional database, we identified 3039 patients undergoing MAG from 1996-2015. Of those, 958 (32%) were operated on by residents and 2081 (68%) by attending surgeons. Propensity score matching and mixed-effects models were used to compare the 2 groups. Operative mortality rate was 0.3% and 0.4% among patients operated by residents and attending surgeons, respectively (P = 0.71), with no significant differences among the groups in postoperative complications. After a mean follow-up time of 11 ± 4 years, survival probability at 5, 10, and 15 years was 95.1% ± 0.7% vs 96.4% ± 0.6%, 87.0% ± 1.1% vs 87.8% ± 1.1%, and 76.6.% ± 1.8% vs 77.6% ± 1.8% in the resident and attending surgeon group, respectively. Resident and attending surgeon cases showed comparable risk of death (hazard ratio [HR] = 1.01; 95% CI: 0.80-1.28; P = 0.92). The equipoise between the 2 groups was confirmed among cases receiving bilateral internal thoracic arteries only (HR = 0.88; 95% CI: 0.54-1.43; P = 0.61), radial artery (HR = 1.22; 95% CI: 0.92-1.61; P = 0.15), or their combination (HR = 0.74; 95% CI: 0.33-1.65; P = 0.47). The present analysis confirms that adequately supervised trainees can perform CABG with MAG without compromising patient safety and long-term survival.

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Training residents in off-pump coronary artery bypass surgery: A 14-year experience

Abstract: OPCAB is a safe and reproducible surgical technique that can be taught successfully to cardiothoracic trainees. Clinical outcomes are unrelated to level of supervision or seniority of trainees.

Cited by 39 publications

References 21 publications

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

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

Teaching operative cardiac surgery in the era of increasing patient complexity: Can it still be done?

How Safe Is it to Train Residents to Perform Coronary Surgery With Multiple Arterial Grafting? Nineteen Years of Training at a Single Institution

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