The impact of surgical training on early and long-term outcomes after isolated aortic valve surgery

Abstract

OBJECTIVES Patients presenting with more comorbidities, requiring more complex cardiac surgical procedures and an increase in public scrutiny are impacting on training programme because of the perceived risk of worse outcomes. Hence, we aimed to provide evidence that trainees as the first operator can achieve comparable results to consultants when performing isolated surgical aortic valve replacement. METHODS From 1996 to 2017, 2919 patients underwent surgical aortic valve replacement at the Bristol Heart Institute, operated on by either a consultant (n = 2220) or a trainee (n = 870) as the first operator. Propensity score matching was used to adjust for imbalance in the baseline characteristics of the 2 groups. RESULTS Over a 21-year period, the proportion of trainee cases dropped from 41.5% to 25.9%. No differences in the rates and risk of in-hospital mortality, new cerebrovascular accidents, re-exploration for bleeding, deep sternal wound infection and length of stay were found between patients operated on in the 2 groups. Also, there was a comparable risk of late death between the 2 groups (HR 0.88; 95% CI 0.73–1.06; P = 0.27) and this was present regardless of trainees career level and patients surgical risk based on the EuroSCORE. Finally, we showed an increase in patients risk profile in the latest year but, this was not associated with the worst outcomes when trainees performed the operation. CONCLUSIONS Surgical aortic valve replacement is a safe and reproducible technique and regardless of the patient’s risk profile, and no differences in the outcomes between trainees and consultant cases were found.

Situación de la capacitación del personal quirúrgico en Perú y Latinoamérica

“…(Radford et al, 2015) No obstante en varios países desarrollados los cirujanos tanto en formación como entrenados reciben entrenamiento constante con tecnología de alta complejidad, más frecuentemente con simulaciones, y con pacientes, donde se imparten nuevas metodologías de aprendizaje. (Dimagli et al, 2021;Jensen et al, 2018;Sellers et al, 2018) Ello para desarrollar conocimientos clínicos básicos, realizar investigaciones académicas, desarrollar infraestructura y capacidad quirúrgica, y convertirse en defensores y colaboradores en entornos de recursos limitados. (Sherif & Davis, 2020) En Canadá, la capacitación de los especialistas está planificada en función y juntos con la formación de médicos y el número de los mismos en su modelo de atención.…”

Are there differences in cardiothoracic surgery performed by trainees versus fully trained surgeons?

“…One study reported solely on outcomes in 3090 patients, following aortic valve replacement 21 . All of them are open valve replacements.…”

“…Of these 434,535 underwent coronary artery bypass grafting (CABG), [10][11][12][13][14][15][16][17][18][19][20] 3090 aortic valve replacements, [21][22][23][24][25] 1740 mitral valve repair/replacement, [24][25][26] 26,433 mixed cardiac surgical cases, 22,24,[27][28][29] 3565 congenital cardiac surgery, 30,31 and 4797 thoracic surgery cases. [32][33][34][35][36][37][38] Total of 398,058 cases were performed by TS and 75,943 by FTS (Table 1).…”

On the left or on the right…side of the table. Where do you stand?

“…There are previous reports that focused on this issue and showed that regardless of the increased risk of nowadays patients trainee cases have similar favourable outcome than when performed by trainers and patients welfare is still preserved and prioritized. 1,6,7 Extension of training to complex operations also facilitates the always challenging transition from trainee to consultant position.…”