Objective

Delivering high quality training in cardiac surgery is dependent on a number of factors. Over recent years, increasing complexity and risk profile of patients, concerns about the publication of surgeon-specific results and the European Working Time Directive may all have influenced trainee operative exposure in cardiac surgery. The objective of this study was to analyse trends in cardiac surgery trainee activity, case mix and outcomes over the past twelve years.

Methods

This was a retrospective study of prospectively collected clinical registry data for consecutive cardiac surgery cases performed at a single institution from 2004-2015. Cases were grouped into four categories; isolated coronary artery bypass graft surgery (CABG), isolated valve surgery, isolated CABG + valve surgery and other cardiac surgery. Multivariable logistic regression was used to assess whether non-consultant first operator was associated with in-hospital mortality.

Results

The study included 13034 cases with a in-hospital mortality rate of 2.5% and mean logistic EuroSCORE of 6.0. A non-consultant was first operator in 16.5%, 8.2%, 4.9% and 5.2% of isolated CABG, isolated valve, CABG + valve and other cases respectively. The proportion of non-consultant cases increased from 11.6% to 13.4% (p=0.002) over the study period. After adjustment, non-consultant first operator was associated with a decreased risk of in-hospital mortality (OR 0.46, 95%CI 0.26-0.83, p=0.010).

Conclusion

Despite perceived negative influences on training in cardiac surgery over recent years, the proportion of cases performed by non-consultants at our institution has increased significantly. Non-consultant operators performed cases across all four procedure groups. Patients who had a non-consultant as the first operator had a lower risk of in-hospital mortality. This study demonstrates that training in contemporary cardiac surgery is feasible and safe.