Halifax, NS - 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."