CABG outcomes similar when performed by residents, attending surgeons
Outcomes in patients who underwent CABG were similar whether the procedure was performed by a cardiac surgery resident or an attending surgeon, according to a prospective analysis of the ROOBY trial presented at the American Association for Thoracic Surgery Annual Meeting.
The ROOBY trial included 2,203 patients enrolled across 18 Veterans Affairs medical centers. The present analysis focused on 1,272 patients randomly assigned to on-pump (n = 633) or off-pump CABG (n = 639). Outcomes and 1-year graft patency were assessed according to whether the primary surgeon who performed the majority of distal anastomoses was a supervised resident or an attending surgeon. Secondary endpoints included clinical outcomes in the short term and at 1 year.
The primary surgeon was a resident in 77.8% of on-pump procedures and 67.4% of off-pump procedures (P < .001). This represented 79.2% of distal coronary anastomoses in the on-pump group and 67.3% of the off-pump group (P = .013). Residents’ training level varied from 6 to 10 postgraduate years.
The intraoperative conversion rate did not differ between residents and attending surgeons in the off-pump group, but attending surgeons had a significantly higher conversion rate than residents in the on-pump group (8.6% vs. 3.2%; P = .006).
Similar rates of short-term mortality and morbidity were observed for residents and attending surgeons in both CABG groups, the researchers wrote. The operative death rate was 0.9% for procedures performed by residents and attending surgeons. Repeat revascularization was reported in 4.4% of patients treated by residents compared with 4.3% of those treated by attending surgeons. Rates of major adverse cardiac events, including all-cause mortality and nonfatal MI, did not differ between residents and attending surgeons. One-year patency also was similar for both the internal mammary artery and saphenous venous grafts.
“These findings strongly support the education and training of residents who will be the future generation of cardiac surgeons,” G. Hossein Almassi, MD, from the Medical College of Wisconsin in Milwaukee, said in a press release. – by Adam Taliercio
Almassi GH, et al. Abstract #50. Presented at: the American Association for Thoracic Surgery Annual Meeting; April 25-29, 2015; Seattle.
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