Resident versus Attending Surgeon Graft Patency and Clinical Outcomes in On- versus Off-Pump Coronary Artery Bypass Surgery

Friday, September 18, 2015

Submitted by

Arie Blitz

Source

Source Name: Journal of Thoracic and Cardiovascular Surgery

Source URL: http://www.jtcvsonline.org/article/S0022-5223(15)01711-0/abstract

Author(s)

G Hossein Almassi, MD, Brendan M. Carr, MD, Muath Bishawi, MD, MPH, A. Laurie Shroyer, PhD, Jacquelyn A. Quin, MD, Brack Hattler, MD, Todd H. Wagner, PhD, Joseph F. Collins, ScD, Pasala Ravichandran, MB, FRCS, Joseph C. Cleveland, MD, Frederick L. Grover, MD, Faisal G. Bakaeen, MD for the VA #517 Randomized On/Off Bypass (ROOBY) Study Group

This sub-study of the Randomized On/Off Bypass (ROOBY) trial compared clinical outcomes and 1-year graft patency between CABG cases where residents vs. attending surgeons were the primary operator. Graft patency rates were similar between resident- vs. attending-completed distal anastomoses for on-pump (83.0% vs. 82.4%) and off-pump (77.2% vs. 76.6%) procedures.

Comments

Submitted by Boris Orlov on Thu, 2015-09-24 23:00

Unbelievable.

Submitted by Rainer Moosdorf on Fri, 2015-09-25 02:36

That´s not unbelievable, because first of all we do have talented residents in cardiovascular surgery and we obviously teach them well. Secondly, during training there is always a selection of cases, which are suited for the residents. The more complex cases are accordingly operated upon by the attending surgeons. Finally, all resident cases are performed under supervision of an experienced surgeon.

Submitted by SOBIROV FAZLIDDIN on Fri, 2015-09-25 03:09

That might be completely true.

Submitted by Arie Blitz on Fri, 2015-09-25 06:50

Dr. Moosdorf makes some great points. When residents are trained, patient selection is modified over the course of time as appropriate for the resident's skill level. I think the important point from this paper, to which the authors allude: if the graft patencies are comparable, attending surgeons are doing a good job of apportioning cases by technical complexity.