Heart Surgeon Trainees Get High Marks

Sept. 29, 2008 -- Would you rather have a young surgeon or a seasoned veteran perform a heart operation on you or a loved one?

Results of a new study may surprise you. According to the research, surgeons-in-training, or residents, did just as well as their mentors on two common operations.

"There doesn't appear to be any significant difference in the long-term outcome comparing cases performed by residents as the primary surgeon or by staff as the primary surgeon," said senior study author Roger J. F. Baskett, MD, of Dalhousie University in Halifax, Canada, in a news release.

Baskett and colleagues collected data on patients who had coronary artery bypass graft surgery, aortic valve replacement, or a combination of these procedures between 1998 and 2005 at the Maritime Heart Center in Halifax, Canada; 1,054 operations performed by residents were compared to 5,877 performed by staff surgeons.

Researchers looked at how many patients died at the hospital, or had other complications such as stroke, bleeding, the need for balloon pump insertion in the aorta (sometimes required when the heart does not recover well from the operation), kidney failure, and/or infection of the sternum.

The average patient age was 65. The patients who had surgery performed by residents tended to be sicker -- with more extensive medical problems and more complex procedures.

Here are some of the key findings:

• One year after surgery, 81% of the staff patients were still alive, compared to 79% of resident patients.
• Three years after surgery, 68% of the patients who were tended to by staff surgeons were still living, as were 67% of the residents' patients.
• Five years after surgery, 59% of the staff patient's were still living, as were 56% of the patients who were treated by residents.

The differences in survival were not statistically significant after accounting for the differences in patient characteristics. There were also no differences in outcome when surgical complications were included in the analysis.

A medical resident is someone who has completed an internship and is receiving specialized training under the watchful eyes of seasoned surgeons.

Baskett says the results show how important good supervision can be.

"The important message is that it is safe to train residents if they are appropriately supervised. It is not only safe, even with complex procedures, but it is very important. That should make patients very comfortable. It is critical that trainees operate because they're going to be the ones operating on the next generation, your kids."

The findings are published in Circulation: Journal of the American Heart Association.