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Training surgeon status is not associated with an increased risk of early or late mortality after isolated aortic valve replacement surgery.
- Source :
-
Cardiology journal [Cardiol J] 2014; Vol. 21 (2), pp. 183-90. Date of Electronic Publication: 2013 Jun 25. - Publication Year :
- 2014
-
Abstract
- Background: Few studies have addressed the effect of "trainee surgeon" status on outcomes after isolated aortic valve replacement (AVR).<br />Methods and Results: A retrospective analysis of data, collected by the Australasian Society of Cardiac and Thoracic Surgeons Cardiac Surgery Database Program between June 2001 and December 2009 was performed. Patient demographics, intra-operative characteristics and early morbidity were compared between trainee and staff cases. Multivariate analyses were used to determine the independent association of training status with 30-day and late mortality. Isolated AVR was performed in 2747 patients; of these, 369 (13.4%) were by trainees. Compared to staff cases, trainee cases were less likely to present with renal failure (1.1% vs. 3.7%, p = 0.010) or in a critical preoperative state (1.4% vs. 3.7%, p = 0.020). The mean EuroSCORE was lower in trainee patients, compared to staff patients (8.11 ± 2.80 vs. 8.81 ± 3.09, p < 0.001). Trainee cases had longer mean perfusion (117.9 min vs. 98.9 min, p < 0.001) and cross-clamp (88.8 min vs. 73.2 min, p < 0.001) times. The incidence of early complications was similar between the two groups, except for post-operative myocardial infarction (1.1% vs. 0.3%, p = 0.008) and red blood cell transfusion (43.9 vs. 40.0%, p = 0.006). On multivariate analysis, trainee status was not associated with an increased risk of 30-day mortality (2.2% vs. 2.4%, p = 0.823). Moreover, there was no significant difference in long-term outcomes and 5-year survival was comparable in both groups (89.9% vs. 84.8%, p = 0.274).<br />Conclusions: Isolated AVR can be safely and effectively performed by trainee surgeons who are strictly supervised in the operating theatre especially during the technically complex parts of the procedure.
- Subjects :
- Aged
Chi-Square Distribution
Databases, Factual
Female
Heart Valve Diseases diagnosis
Heart Valve Diseases mortality
Heart Valve Prosthesis Implantation adverse effects
Hospital Mortality
Humans
Logistic Models
Male
Multivariate Analysis
Operative Time
Postoperative Complications therapy
Proportional Hazards Models
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Victoria
Aortic Valve surgery
Clinical Competence
Education, Medical, Graduate
Heart Valve Diseases surgery
Heart Valve Prosthesis Implantation education
Heart Valve Prosthesis Implantation mortality
Internship and Residency
Postoperative Complications mortality
Surgeons education
Subjects
Details
- Language :
- English
- ISSN :
- 1898-018X
- Volume :
- 21
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Cardiology journal
- Publication Type :
- Academic Journal
- Accession number :
- 23799562
- Full Text :
- https://doi.org/10.5603/CJ.a2013.0087