Newswise — When educating medical students or residents to perform highly technical procedures, there is always a challenge to balance the educational mission with maintaining quality results and optimal patient care. This report compared outcomes of cardiac surgery residents to those of attending physicians in performing coronary artery bypass grafting. It found no differences in patient outcomes or graft patency between the residents and attending surgeons.
Seattle WA, April 28, 2015 – A conundrum in medical education is how to train residents in complex and technically difficult procedures without reducing the quality of patient care. In an analysis of prospective data from a study of coronary artery bypass grafting (CABG), no differences were found in short-term or one-year patient outcomes and patency of grafts between properly-supervised residents and attending surgeons. G. Hossein Almassi, MD, is presenting the results of this research at the 95th AATS Annual Meeting in Seattle, WA on April 28, 2015.
“These findings strongly support the education and training of residents who will be the future generation of cardiac surgeons,” stated Dr. Almassi, a professor of cardiothoracic surgery at the Medical College of Wisconsin (Milwaukee).
This was an analysis of prospectively collected data from the ROOBY (Randomized On/Off Bypass) trial, the world’s first large trial that was designed to compare outcomes from standard CABG with the use of a heart-lung machine to the beating heart bypass grafting technique. Eighteen Veterans Affairs (VA) medical centers took part in the study and 2203 patients were enrolled. Most of the medical centers were affiliated with academic medical schools and 16 participated in the training and education of both medical students and cardiac surgery residents.
The level of residents’ training varied between postgraduate year 6 and 10 postgraduate year. The results showed that residents acted as the primary surgeon in the majority of surgeries: 77.8% (493/633) of on-pump CABG procedures and 67.4% (431/639) of off-pump procedures. This difference was statistically significant (p<.001). This corresponded to 79.2% and 67.3% of the distal coronary anastomoses in the on-pump group and off-pump groups, respectively (p=0.013). There were no differences in patient characteristics between those operated on by the residents compared to those operated on by the surgical attending physicians.
No differences between surgeon groups were found in short-term perioperative morbidity (e.g. myocardial infarction, reoperation for bleeding, stroke, new mechanical circulatory support, reintubation, prolonged ventilator support, mediastinitis or renal failure) or mortality. For example, the operative death rate was 0.9% for both residents and attendings. At one year following surgery, the rate of repeat revascularization was 4.4% for the residents and 4.3% for attendings. Rates for other major adverse cardiac events (MACE, including all-cause death, non-fatal myocardial infarction)) and graft patency were also similar for the two groups.
“Concerns about the outcomes of surgeries performed by physicians-in-training are heightened by the establishment of integrated thoracic surgery training programs,” explained Dr. Almassi. In these six-year programs, residents do not have the surgical training afforded by the traditional four or five years of general surgery prior to beginning cardiothoracic surgery training.” Nevertheless, Dr. Almassi commented that with appropriate case selection and supervision, ROOBY documents that residents performed CABG with similar outcomes to attending surgeons.
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NOTES FOR EDITORS“Resident versus Attending Surgeon Patency and Clinical Outcomes in On- versus Off-pump Coronary Artery Bypass Surgery,” by G. Hossein Almassi, Muath Bishawi, Annie Laurie Shroyer, Jacquelyn A. Quin, Brack Hattler, Todd H. Wagner, Joseph F. Collins, Joseph C. Cleveland, Frederick L. Grover, Faisal G Bakaeen. Presentation at the 95th AATS Annual Meeting. April 25-29, 2015. Seattle, WA, during the Plenary Scientific Session on April 28, 2015 at 10:40 AM PT. http://aats.org/annualmeeting
For more information contact Nicole Baritot, Managing Editor, AATS Scientific Publications, at +1 978-299-4520 or [email protected] Journalists wishing to interview Dr. Almassi may contact him at +1 414-510-7414 or [email protected] The presentation abstract is located at http://aats.org/annualmeeting/Program-Books/2015/50.cgi.
ABOUT THE AUTHORSG. Hossein Almassi, Medical College of Wisconsin, Milwaukee, WIMuath Bishawi, Duke University, Durham, NC Annie Laurie Shroyer, Northport Veterans Affairs Medical Center and Stony Brook University School of Medicine, Stony Brook, NYJacquelyn A. Quin, VA Boston Healthcare System, West Roxbury, MABrack Hattler, Veteran Affairs Eastern Colorado Health Care System, Denver, COTodd H. Wagner, Veterans Affairs Palo Alto Health Economics Resource Center, Menlo Park, CA Joseph F. Collins, Cooperative Studies Program Coordinating Center and VA Medical Center, Perry Point, MDJoseph C. Cleveland, University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, COFrederick L. Grover, Surgery University of Colorado School of Medicine at the Anschutz Medical Campus, Denver, COFaisal G. Bakaeen, Baylor College of Medicine and Houston VA Medical Center, Houston, TX, Houston, TX
ABOUT THE AMERICAN ASSOCIATION FOR THORACIC SURGERY (AATS)The American Association for Thoracic Surgery (AATS) is an international organization of over 1,300 of the world’s foremost thoracic and cardiothoracic surgeons, representing 41 countries. AATS encourages and stimulates education and investigation into the areas of intrathoracic physiology, pathology and therapy. Founded in 1917 by a respected group of the last century’s earliest pioneers in the field of thoracic surgery, the AATS’ original mission was to “foster the evolution of an interest in surgery of the Thorax.”
One hundred years later, the AATS continues to be the premiere association among cardiothoracic surgeons. The purpose of the Association is the continual enhancement of the ability of cardiothoracic surgeons to provide the highest level of quality patient care. To this end, the AATS encourages, promotes, and stimulates the scientific investigation and study of cardiothoracic surgery. Visit www.aats.org.