Cardiac-surgery patients treated by senior residents are no more
likely to die or return to the hospital for cardiac complications
than are patients treated by staff surgeons, a new, single-center
study suggests [1]. The findings, write Dr Serban C Stoica (Maritime
Heart Center, Halifax, NS) and colleagues, extend those from studies
that have reached similar conclusions but looked only at in-hospital
morbidity and mortality.

The study is published online September 29, 2008 in Circulation.

Stoica et al point out that surgeons in training might be expected
to have good in-hospital results given the close supervision they
are under; indeed, an earlier paper by the same group showed that in-
hospital morbidity and mortality is similar for patients treated
with both staff surgeons and residents. But as Dr Roger JF Baskett
(Maritime Heart Center), senior author on the study, told heartwire,
it was important to look at how patients did over the longer
term. "It's conceivable that if you didn't see a difference in in-
hospital morbidity and mortality, maybe you would see it down the
road, where if some of those bypass grafts maybe weren't as good,
you might see more deaths in the long run."

Their study therefore compared in-hospital outcomes as well as late
survival and cardiovascular hospital readmissions for patients
treated during teaching cases and nonteaching cases. They found that
while residents were more likely to operate on patients with higher-
risk features, such as reduced LV function, atrial fibrillation,
repeat surgeries, or urgent/emergent MI, patients operated on by
residents rather than staff surgeons were no more likely to die or
require cardiovascular rehospitalization. Rates of in-hospital
outcomes were also similar.

"Our results strongly support the view that cardiac operations
performed by surgeons in training are not associated with adverse
outcomes after hospital discharge," the authors conclude.

To heartwire, Baskett acknowledged that his center may differ from
some other teaching hospitals in that residents are encouraged, and
indeed ask, to do tougher cases. But overall, he said, the results
from this study are likely generalizable to other hospitals and
countries, since the "model" of cardiac surgery training is more or
less the same: basically an apprenticeship program, with graduated
responsibility tailored to the skill of the individual trainee.

Overall, Baskett says, patients and administrators alike should be
reassured by the study findings.

"I've certainly heard from surgeons elsewhere who have patients tell
them very specifically: 'I don't want a trainee doing my case--
you're going to do the whole thing, right?' So the issue does come
up. But we have to train new surgeons, because, as I say to my
patients, who is going to do your son's or your daughter's
operation? It's not going to be me; it's going to be the guys I'm
training. So I think this is an important question: are we doing
this right from a patient safety/quality point of view? And I think
people can gain a lot of reassurance from this study that we seem to
be doing this right."


Stoica SC, Kalavrouziotis D, Martin BJ, et al. Long-term results of
heart operations performed by surgeons in training. Circulation
2008; DOI:10.1161/CIRCULATIONAHA.107.756379. Available at:
http://circ.ahajournals.org.