Objective

A number of factors may negatively impact on training in cardiothoracic surgery. These factors may include the increasing complexity and risk profile of patient undergoing cardiac surgery, concerns about the publication of surgeon-specific results and a perception that training leads to prolonged operative times. The objective of this study was to analyse the impact of training on operative timings in isolated coronary artery bypass graft surgery (CABG).

Methods

Prospectively collected clinical registry data for consecutive isolated CABG procedures performed at a single institution between January 2015 and March 2015 were analysed. Data on who performed each constituent part of the operation were available. A trainee was defined as a national trainee or a clinical fellow. A trainee case was defined as per the new Specialist Advisory Committee (SAC) guidelines. Multivariable linear regression was used to assess the impact of training on operation time.

Results

A total of 150 cases were included. The majority were elective (72%) and most (68%) were on-pump. A trainee was first operator in 29% of cases. Mean surgical time was 243 (SD 49) minutes. Total number of anastomoses (P<0.001) and proportion of operation performed by the trainee (p=0.018) were associated with increased surgical time. Proportion of anastomoses performed by the trainee, or trainee considered first operator, were not associated with increased surgical, bypass or cross clamp times.

Conclusion

This study demonstrates that the proportion of an isolated CABG procedure performed by a trainee is significantly associated with a longer surgical time. However, the proportion of anastomoses performed by the trainee and whether the trainee met the SAC guidelines for performing the case were not associated with increased surgical time, cardiopulmonary bypass time or cross clamp time. This study has potential implications for training in cardiac surgery.