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Original Articles: Adult Cardiac

Does the Level of Experience of Residents Affect Outcomes of Coronary Artery Bypass Surgery?

^a Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Houston, Texas
^b Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
^c The Ben Taub Hospital, Houston, Texas
^d The Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
^e The Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas

Accepted for publication December 18, 2008.

^_* Address correspondence to Dr Bakaeen, Department of Cardiothoracic Surgery, Michael E. DeBakey Veterans Affairs Medical Center, OCL 112, 2002 Holcombe Boulevard, Houston, TX 77030 (Email: fbakaeen{at}bcm.edu).

Presented at the Fifty-fifth Annual Meeting of the Southern Thoracic Surgical Association, Austin, TX, Nov 5–8, 2008.

Background: At our institution, coronary artery bypass grafting (CABG) operations are performed by staff surgeons or by first- or second-year cardiothoracic residents under the direct supervision of attending surgeons. We evaluated the influence of surgical seniority on outcomes.

Methods: Using prospectively collected data from our departmental database, we identified all primary, isolated CABG operations (n = 1,042) performed between July 1997 and April 2007. Operations were then stratified according to the seniority of the primary surgeon: first-year cardiothoracic resident (CT1), second-year cardiothoracic resident (CT2), or staff surgeon. Data were examined for any association between seniority and surgical outcomes.

Results: Staff, CT2, and CT1 surgeons performed 47 (4%), 610 (59%), and 385 (37%) cases, respectively. Efficiency was correlated with experience: for CT1, CT2, and staff surgeons, respectively, operative times averaged 345, 313, and 302 minutes; perfusion times averaged 118, 106, and 96 minutes; and cross-clamp times averaged 68, 58, and 57 minutes (p < 0.05 for all comparisons). The incidences of major morbidity (10.1%, 12.3%, 12.8%) and operative mortality (0.8%, 1.5%, 2.1%) were similar after operations performed by CT1, CT2, and staff surgeons, respectively (p > 0.15 for all). In univariate and multivariate analyses, the seniority of the primary surgeon did not independently predict morbidity or perioperative mortality. On follow-up (mean, 1,485 ± 1,015 days), there was no significant difference in patient survival (log-rank, p = 0.64).

Conclusions: Lower academic seniority was associated with longer CABG operative times but did not affect outcomes. Thus, training residents to perform CABG is safe and is characterized by progressive improvement in their technical efficiency.

This article has been cited by other articles:

				F. G. Bakaeen, J. Huh, S. A. LeMaire, J. S. Coselli, S. Sansgiry, P. V. Atluri, and D. Chu The July effect: impact of the beginning of the academic cycle on cardiac surgical outcomes in a cohort of 70,616 patients. Ann. Thorac. Surg., July 1, 2009; 88(1): 70 - 75. [Abstract] [Full Text] [PDF]