Impact of residency status on perfusion times and outcomes for coronary artery bypass graft surgery.

BACKGROUND: A price of training residents in cardiothoracic surgery is often perceived to be a loss in intraoperative efficiencies, leading to prolonged cardiopulmonary bypass and perfusion time. Because these indicators are also thought to adversely affect operative outcome, we investigated the association between residency training status, perfusion times, and outcomes. METHODS: Using the Society of Thoracic Surgeons (STS) National Cardiac Database, we studied 369,906 CABG patients undergoing isolated coronary artery bypass graft (CABG) procedures during January 2002 through June 2005. Participating institutions were stratified by residency versus nonresidency status and by perfusion time categories and analyzed for association with clinical outcomes. RESULTS: Overall, 57 (10%) of 594 STS participants had a residency training program. Residency programs had longer mean cross-clamp and perfusion times than nonresidency programs, 73.10 versus 67.44 minutes and 104.75 versus 98.00 minutes, respectively (p < 0.0001 for both. Longer perfusion time was significantly associated with higher operative mortality at the patient level. Unadjusted mortality rates were, however, similar for patients at residency and nonresidency programs (2.30% versus 2.27%), with an adjusted odds ratio of 0.96 (95% confidence interval, 0.84 to 1.09). Although perfusion times have not changed significantly over time between residency and nonresidency programs, mortality rates have significantly improved over time at each. CONCLUSIONS: Residency programs have longer CABG perfusion times than nonresidency cardiothoracic surgery programs, but these differences are minor. Adjusted procedural outcomes at residency training programs are similar to those at nonresidency centers; thus, patients do not appear to be adversely impacted by the time costs of surgical training.

Duke Scholars

Author Sean Michael O'Brien Biostatistics & Bioinformatics, Division of Biostatistics

Author Daniel Benjamin Mark Medicine, Cardiology