Thorac Cardiovasc Surg 2001; 49(2): 75-77
DOI: 10.1055/s-2001-11710
Original Cardiovascular
© Georg Thieme Verlag Stuttgart · New York

Risk Stratification for Training in Cardiac Surgery[1]

D. P. Jenkins, O. Valencia, E. E. J. Smith
  • Department of Cardiothoracic Surgery, St George's Hospital, London, UK
Further Information

Publication History

Publication Date:
31 December 2001 (online)

Background: 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. Methods: 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. Results: 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 %). Conclusions: 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.

1 This work was presented at the Symposium on Risk Stratification in Cardiac and Thoracic Surgery in Cologne on October 15 - 16, 1999

References

  • 1 UK Cardiac surgical register .Society of Cardiothoracic Surgeons of Great Britain and Ireland,. Concorde Services, London 1997/8
  • 2 Keogh B E, Kinsman R. National adult cardiac surgical database report. Society of Cardiothoracic Surgeons of Great Britain and Ireland, Concorde Services, London 1998
  • 3 Calman K. Implementing the reforms of specialist medical training: commissioning the specialist registrar grade. CMO 1. Department of health, London 1996
  • 4 Anderson J R, Unsworth-White M J, Valencia O, Parker D J, Treasure T. Training surgeons and safeguarding patients.  Ann R Coll Surg Eng. 1996;  78 116-118
  • 5 Cool P, Morgan-Jones R L, Oliver C W, Richardson J B. The audit of orthopaedic trainee teaching improves supervision rates.  Ann R Coll Surg Eng. 1999;  81 195-197
  • 6 Parsonnet V, Dean D, Bernstein A D. A method of uniform stratification of risk for evaluating the results of surgery in acquired heart disease.  Circulation. 1989;  79 I3-12
  • 7 English T A H, Bailey A R, Dark J F, Williams W G. The UK cardiac surgical register 1977 - 82.  BMJ. 1984;  289 1205-1208
  • 8 Keogh B E, Dussek J, Watson D, Magee P, Wheatley D. Public confidence and cardiac surgical outcome.  BMJ. 1998;  316 1759-1760

1 This work was presented at the Symposium on Risk Stratification in Cardiac and Thoracic Surgery in Cologne on October 15 - 16, 1999

E. E. J. Smith

Consultant Cardiothoracic Surgeon
St George's Hospital
Department of Cardiothoracic Surgery (Knightsbridge Wing)

Blackshaw Road

London SW 17 OQT

United Kingdom

Phone: +44 (0)181 672 1255