Training surgeon status is not associated with an increased risk of early or late mortality after isolated aortic valve replacement surgery

Saxena, Akshat; Dinh, D.; Smith, Julian Anderson; Reid, Christopher M.; Shardey, Gilbert; Newcomb, Andrew

doi:10.5603/cj.a2013.0087

Cited by 12 publications

(6 citation statements)

References 30 publications

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“…There were no differences in postoperative complications between the two groups when the incidence of resternotomy for bleeding/tamponade, stroke, myocardial infarction, ITU stay, pacemaker implantation, new renal failure requiring dialysis, and total hospital stay 24–26 …”

Section: Resultsmentioning

confidence: 97%

“…There were no mortality differences between TS and FTS. The in‐hospital mortality for TS is reported as 2% versus 6% in FTS cohorts 24–26 …”

Section: Resultsmentioning

confidence: 99%

“…TS had a median CPB time of 121 min (range 93.2−146.3) versus FTS 121 min (range 97−153). The XCT for TS were 85 min (range 70−105.3) versus FTS 84 min (range 67−106) 24–26 …”

Section: Resultsmentioning

confidence: 99%

“…The XCT for TS were 85 min (range 70−105.3) versus FTS 84 min (range 67−106). [24][25][26] There were no differences in postoperative complications between the two groups when the incidence of resternotomy for bleeding/tamponade, stroke, myocardial infarction, ITU stay, pacemaker implantation, new renal failure requiring dialysis, and total hospital stay. [24][25][26] There were no mortality differences between TS and FTS.…”

Section: Euroscore Reported As 6 (Range 4−7) Ts and 6 (Range 4−8)mentioning

confidence: 92%

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Are there differences in cardiothoracic surgery performed by trainees versus fully trained surgeons?

Comanici

Salmasi

Schulte

et al. 2022

Journal of Cardiac Surgery

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Objectives We sought to assess the safety of training in cardiothoracic surgery comparing outcomes of cases performed by trainees versus fully trained surgeons. Methods EmBase, Scopus, PubMed, and OVID MEDLINE were searched in August 2021 independently by two authors. A third author arbitrated decisions to resolve disagreements. Inclusion criteria were articles on cardiothoracic surgery reporting on outcomes for trainees. Studies were assessed for appropriateness as per CBEM criteria. Eight hundred and ninety‐two results were obtained, 27 represented best evidence (2‐meta‐analyses, 1‐RCT, and 24 retrospective cohort studies). Results In all 474,160 operative outcomes were assessed for 434,535 coronary artery bypass grafting (CABG) (431,329 on‐pump vs. 3206 off‐pump), 3090 AVR, 1740 MVR/repair, 26,433 mixed, 3565 congenital, and 4797 thoracic procedures. In all 398,058 cases were performed by trainees and 75,943 by consultants. One hundred fifty‐nine cases were indeterminate. There were no statistically significant differences in the patients' preoperative risk scores. All studies excluded extreme high‐risk patients in emergency setting, patients with poor left ventricular function, and reoperation cases that were undertaken by consultants. There were no differences in cardiopulmonary bypass and clamp times for CABG. Times for valve replacement and repair cases were longer for trainees. There were no differences in the postoperative outcomes including perioperative myocardial infarction, resternotomy for bleeding, stroke, renal failure, intensive therapy unit length of stay, and total length of stay. One study reported no differences on angiographic graft patency at 1 year. There were no differences in in‐hospital or midterm mortality out to 5‐years. Discussion Trainees can perform cardiothoracic surgery in dedicated high‐volume units with outcomes comparable to those of fully trained surgeons.

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Section: Resultsmentioning

confidence: 97%

“…There were no mortality differences between TS and FTS. The in‐hospital mortality for TS is reported as 2% versus 6% in FTS cohorts 24–26 …”

Section: Resultsmentioning

confidence: 99%

“…TS had a median CPB time of 121 min (range 93.2−146.3) versus FTS 121 min (range 97−153). The XCT for TS were 85 min (range 70−105.3) versus FTS 84 min (range 67−106) 24–26 …”

Section: Resultsmentioning

confidence: 99%

Section: Euroscore Reported As 6 (Range 4−7) Ts and 6 (Range 4−8)mentioning

confidence: 92%

See 2 more Smart Citations

Are there differences in cardiothoracic surgery performed by trainees versus fully trained surgeons?

Comanici

Salmasi

Schulte

et al. 2022

Journal of Cardiac Surgery

View full text Add to dashboard Cite

show abstract

“…Moreover, only 2 studies reported on the comparison of mid- and long-term mortality between trainees’ and consultants’ cases and no difference was found [ 11 , 12 ]. Compared to these studies, we reported on longer mean follow-up outcome and demonstrated that the equipoise between trainees’ and consultants’ cases persists during a longer follow-up.…”

Section: Discussionmentioning

confidence: 99%

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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Assistentenbefragung 2016 des Jungen Forums der DGTHG

Helms

Rost

Linden

et al. 2018

Z Herz- Thorax- Gefäßchir

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Training surgeon status is not associated with an increased risk of early or late mortality after isolated aortic valve replacement surgery

Abstract: Background: Few studies have addressed the effect of "trainee surgeon" status on outcomes after isolated aortic valve replacement (AVR). Methods and Results: (Cardiol J 2014; 21, 2: 183-190)

Cited by 12 publications

References 30 publications

Are there differences in cardiothoracic surgery performed by trainees versus fully trained surgeons?

Are there differences in cardiothoracic surgery performed by trainees versus fully trained surgeons?

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

Assistentenbefragung 2016 des Jungen Forums der DGTHG

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