Risk stratification for training in cardiac surgery

Thorac Cardiovasc Surg. 2001 Apr;49(2):75-7. doi: 10.1055/s-2001-11710.


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.

MeSH terms

  • Adult
  • Cardiac Surgical Procedures / education*
  • Clinical Competence
  • Education, Medical, Continuing
  • Education, Medical, Graduate
  • Educational Measurement*
  • Female
  • Humans
  • Internship and Residency
  • Male
  • Medical Audit
  • Retrospective Studies
  • Risk Assessment
  • United Kingdom