Trainee inexperience is associated with longer procedure times but no increase in complications for cardiac device implantation

Heart Rhythm. 2013 Dec;10(12):1755-8. doi: 10.1016/j.hrthm.2013.09.003. Epub 2013 Sep 6.


Background: The "July phenomenon" describes poor patient outcomes in teaching hospitals at the beginning of a new academic year when trainees begin. Whether this phenomenon truly exists is unclear.

Objective: The purpose of this study was to identify whether trainee and attending inexperience is associated with cardiac electrophysiologic procedural outcomes including total procedure time, fluoroscopy time, and complications.

Methods: We retrospectively reviewed the available electronic records of 488 consecutive patients undergoing initial dual-chamber pacemaker (PM) or cardiac resynchronization therapy (CRT) device implantation performed at University of California, San Francisco from February 2004 through November 2011. We calculated physician's year of experience using the procedure date and the physician's job start date. Patients were stratified into two subgroups based on their device type. Procedural outcomes including procedure length, fluoroscopy time, and complications were retrieved from electronic databases.

Results: After multivariate analysis, fellow experience was associated with decreased procedure time (19% less procedure time/year of experience, 95% confidence interval [CI] 13%-25%, P <.001 in the PM subgroup; and 15% less procedure time/year of experience, 95% CI 7%-23%, P <.001 in the CRT subgroup). Fellow experience was associated with decreased fluoroscopy time in the CRT subgroup (19% less fluoroscopy time/experience years, 95% CI 5%-34%, P = .009). Neither fellow nor attending experience was associated with complications.

Conclusion: Each year of fellow experience is associated with a decrease in cardiac device implantation procedure time and a decrease in fluoroscopy time during CRT implantation. No associations between fellow experience and in-hospital complications were observed.

Keywords: CI; CRT; Cardiac resynchronization therapy devices; EP; Fellowship; Fluoroscopy; Implantable cardioverter-defibrillator; PM; Pacemaker; cardiac resynchronization therapy; confidence interval; electrophysiology; pacemaker.

MeSH terms

  • Aged
  • California / epidemiology
  • Cardiology / education*
  • Clinical Competence / standards*
  • Defibrillators, Implantable*
  • Education, Medical, Continuing / standards*
  • Faculty / standards*
  • Female
  • Fluoroscopy / adverse effects
  • Follow-Up Studies
  • Heart Failure / therapy*
  • Hospitals, Teaching
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Operative Time*
  • Postoperative Complications / epidemiology
  • Postoperative Complications / etiology
  • Retrospective Studies
  • Time Factors