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Training the novice to become cardiac surgeon: Does the "early learning curve" training compromise surgical outcomes?

Lookup NU author(s): Professor Pradip Sarkar

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Abstract

Objective: It is unclear whether novice trainees can be taught safely to perform adult cardiac surgery without any impact on early or late outcomes. Methods: All patients (n = 1305) data were obtained from an externally validated, mandatory institutional database (2003-2010). 'Novice' is defined as a trainee who required substantial assistance or supervision to perform part or whole of the specified procedure (Intercollegiate Surgical Curriculum Programme UK, Competency Level ≤2). Outcome measures were in-hospital mortality, composite score of in-hospital mortality-morbidities, mid-term survival and revascularisation rate after CABG. Follow-up up to 7 years (median 3.2 years) was determined. Results: Some 39 % (n = 510) of the cases involved novice (28 %-part, 11 %-whole procedure), 12 % (n = 157) competent trainees and 49 % (n = 638) consultant. Median EuroSCORE was higher in consultant group (p < 0.001). Without risk adjustment, composite outcome score and mid-term mortality were higher in consultant group (p = 0.03). With adjustment using EuroSCORE and propensity scores, EuroSCORE was significantly predictive of in-hospital mortality [odd ratio (OR) 1.38, 95 %CI 1.20-1.57, p < 0.001], composite outcome (OR 1.26, 95 %CI 1.15-1.37, p < 0.001) and mid-term mortality (HR 1.24, 95 %CI 1.18-1.31, p < 0.001) but not the operator categories. Further analysis of subcohort undergoing first-time, isolated CABG (n = 1070) showed that EuroSCORE remained predictive of adjusted in-hospital mortality (OR 1.39, 95 %CI 1.13-1.71, p = 0.002), composite outcome (OR 1.33, 95 %CI 1.19-1.49, p < 0.001) and mid-term mortality (HR 1.22, 95 %CI 1.10-1.35, p < 0.001). The operator categories were not associated with adjusted outcome measures including revascularisation rate after CABG. Conclusion: Supervised training in adult cardiac surgery can be achieved safely at the early learning curve phase without compromising both early and mid-term clinical outcomes. © 2013 The Japanese Association for Thoracic Surgery.

Publication metadata

Author(s): Peng E, Sarkar PK

Publication type: Article

Publication status: Published

Journal: General Thoracic and Cardiovascular Surgery

Year: 2014

Volume: 62

Issue: 3

Pages: 149-156

Print publication date: 01/03/2014

Online publication date: 01/10/2013

Acceptance date: 09/09/2013

ISSN (print): 1863-6705

ISSN (electronic): 1863-6713

Publisher: Springer-Verlag Tokyo

URL: https://doi.org/10.1007/s11748-013-0321-6

DOI: 10.1007/s11748-013-0321-6

PubMed id: 24078280

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