Training in Cardiac Surgery

Objectives: Training in cardiac surgery is demanding and a slow process. Many concerns are there about patients’ safety. This work evaluated the performance of surgical trainees in our department to address this subject.

Methods: The performance of 62 surgeons of different expertise levels, who performed together 13,753 CABG over 15 years, was analyzed. CABGs were divided according to the count of CABGs accomplished by the surgeon up to the date of the surgery in six groups: CABGs were done by beginners, trainees (who have done >20), advanced trainees (>80), consultants (>200), advanced consultants (>500), and seniors (>1,500). The classification was arbitrary.

Result:

	Total of pat.	Total of surgeons	Op- time	Total of anast.	ICU stay	Wound revision	Cal. Log. Euroscore	Periop. mortality
Beginners	453	32	249	2.45	3.2	4.9%	3.1%	2.0%
Trainees	883	24	239	2.45	3.0	4.8%	3.5%	2.4%
A. trainees	1,256	16	236	2.51	3.1	4.9%	4.2%	4.5%
Consultants	1,726	12	222	2.47	3.5	5.7%	4.9%	4.3%
A. consultants	2,458	11	222	2.25	3.2	3.3%	4.3%	4.4%
Seniors	6977	9	190	2.38	3.5	2.4%	4.2%	4.0%
Total	13,753	62	209	2.39	3.4	3.4%	4.2%	4.0%

Mortality was slightly, but significantly, lower in the first two groups (p = 0.007 and 0.005). There were no significant differences in the numbers of anastomoses, the number of IMAs, cardiopulmonary bypass time, ICU stay, ventilation time, in-hospital stay, postoperative infection, respiratory insufficiency, and delirium incidence. Skin-to-skin time corresponds significantly and inversely with the number of surgeries done by the surgeons (p < 0.0001). A significant reduction in wound revision rates was noticed after accomplishing more than 500 surgeries (p < 0.0001).

Conclusion: With a suitable supervision and patient selection, surgical trainees can perform CABG with acceptable results and without compromising the patient’s safety when given a longer skin-to-skin time.