Risk stratification for training in cardiac surgery.

Abstract

There is a potential conflict of interest in providing the best possible outcome for patients undergoing cardiac surgery and good training for junior cardiac surgeons. We analysed training with reference to volume of work, risk stratification and outcome for consultant and trainee procedures. The Parsonnet system was used for risk stratification. A retrospective audit was performed for a 6-year period. During the study period, 6037 operations were performed, of which 2166 were carried out by trainees. Direct consultant assistance in a trainee operation varied between 17% and 51% and increased towards the end of the study period. Of the operations performed by trainees, 88% were CABG. The median Parsonnet score for consultant operations was 9 compared with 4 for trainees. Actual mortality was below predicted for all surgeons. Morbidity was also lowest for trainees (10%). With appropriate case selection, trainees in cardiac surgery can achieve good results. As training changes in the UK, trainees should receive increased supervised exposure to a wider range of procedure to compensate for a lower volume of workload.