Are there differences in cardiothoracic surgery performed by trainees vs
fully trained surgeons?
Objectives: We sought to assess the safety of training in
cardiothoracic surgery comparing outcomes of cases performed by trainees
versus fully trained surgeons. Methods: EmBase, Scopus, PubMed,
and OVID MEDLINE were searched in August 2021 independently by two
authors. A third author arbitrated decisions to resolve disagreements.
Inclusion criteria were articles on cardiothoracic surgery reporting on
outcomes for trainees. Studies were assessed for appropriateness as per
CBEM criteria. 892 results were obtained, 27 represented best evidence
(2-Meta-analyses, 1-RCT and 24 retrospective cohort studies).
Results: 474,160 operative outcomes were assessed for 434,535
CABG (431,329 on-pump vs 3206 off-pump), 3090 AVR, 1740 MVR/repair,
26,433 mixed, 3565 congenital and 4797 thoracic procedures. 398,058
cases were performed by trainees and 75,943 by consultants. 159 cases
were indeterminate. There were no statistically significant differences
in the patients’ pre-operative risk scores. All studies excluded extreme
high-risk patients in emergency setting, patients with poor left
ventricular function and re-operation cases that were undertaken by
consultants. There were no differences in CPB and clamp times for CABG.
Times for valve replacement and repair cases were longer for trainees.
There were no differences in the post-operative outcomes including
peri-operative myocardial infarction, resternotomy for bleeding, stroke,
renal failure, ITU length of stay and total length of stay. One study
reported no differences on angiographic graft patency at 1 year. There
were no differences in in-hospital or mid-term mortality out to
five-years. Discussion: Trainees can perform cardiothoracic
surgery in dedicated high-volume units with outcomes comparable to those
of fully trained surgeons.