| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 2004;78:1236-1240
© 2004 The Society of Thoracic Surgeons
a The Maritime Heart Center, Halifax, Nova Scotia, Canada
Accepted for publication April 12, 2004.
* Address reprint requests to Dr Baskett, The Maritime Heart Center, Room 2269, 1796 Summer St, Halifax, Nova Scotia, Canada B3H 3A7
rogerbaskett{at}hotmail.com
BACKGROUND: The safety of training residents in complex procedures has not been elucidated. In particular, the impact of resident-performed mitral valve surgery on patient outcomes is unknown.
METHODS: All mitral valve procedures performed by residents between 1998 and 2003 were compared with those performed by staff surgeons. Operative mortality and a composite morbidity (reoperation for bleeding, myocardial infarction, infection, stroke, or ventilation > 24 hours) were compared using multivariate analysis. Individual outcomes were compared with the use of propensity scores.
RESULTS: There were 1020 cardiac surgeries performed by residents, including 165 mitral valve procedures (86 replacements, 79 repairs). In the same period, the staff surgeons performed 261 mitral procedures. Crude operative mortality for isolated mitral procedures was 5.4% and 4.7% (resident and staff, respectively, p = 1.00). Mitral valve repair including combined procedures had an operative mortality of 3.8% and 4.3% (resident and staff, respectively, p = 1.00). The composite morbidity outcome was 29.7% and 35.3% for resident and staff-performed cases, respectively (p = 0.24). In multivariate analysis, resident was not associated with the adverse outcomes examined (OR 0.80, 95% CI, 0.47, 1.37). The incidence of major adverse outcomes for propensity score-matched mitral valve cases, including combined procedures, were similar between residents and staff, respectively: mortality, 7.4% versus 8.7% (p = 0.67), stroke, 4.0% versus 6.7% (p = 0.30), and reoperation for bleeding, 4.7% versus 9.4% (p = 0.11).
CONCLUSIONS: There were no significant differences in morbidity and mortality in patients undergoing mitral valve surgery between resident and staff surgeons. It is possible to train residents to perform complex cardiac cases without adversely affecting outcomes.
This article has been cited by other articles:
|
|
 |
|
  T. P Grantcharov and R. K Reznick Teaching procedural skills BMJ, May 17, 2008; 336(7653): 1129 - 1131. [Full Text] [PDF]
|
|
|
|
 |
|
 P. C. Austin Propensity-score matching in the cardiovascular surgery literature from 2004 to 2006: a systematic review and suggestions for improvement. J. Thorac. Cardiovasc. Surg., November 1, 2007; 134(5): 1128 - 1135. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Karagounis, G. Asimakopoulos, G. Niranjan, O. Valencia, and V. Chandrasekaran Complex off-pump coronary artery bypass surgery can be safely taught to cardiothoracic trainees Interactive CardioVascular and Thoracic Surgery, June 1, 2006; 5(3): 222 - 226. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Asimakopoulos, A. P. Karagounis, O. Valencia, D. Rose, G. Niranjan, and V. Chandrasekaran How Safe Is It to Train Residents to Perform Off-Pump Coronary Artery Bypass Surgery? Ann. Thorac. Surg., February 1, 2006; 81(2): 568 - 572. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Alexiou, G. Doukas, M. Oc, B. Oc, L. Hadjinikolaou, and T. J. Spyt Effect of Training in Mitral Valve Repair Surgery on the Early and Late Outcome Ann. Thorac. Surg., July 1, 2005; 80(1): 183 - 188. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
