Open heart · 2026
Trainee exposure to valve surgery in the UK: safety, decline and organisational inequality in a national cohort.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Chan Jeremy, Comanici Maria, Narayan Pradeep, Dong Tim, Angelini Gianni D
Аннотация
OBJECTIVE: To evaluate trends, early clinical outcomes and surgeon-variation and hospital-variation in trainees performing isolated aortic valve replacement (AVR) and mitral valve (MV) surgery, including replacement (MVR) and MV repair (MVr) in the UK.
METHODS: All adults undergoing elective or urgent isolated AVR or isolated MVr/MVR in the National Adult Cardiac Surgery Audit between 1996 and 2019 were included. Temporal trends and early clinical outcomes were compared between consultants and trainees as primary operators. Three-level multilevel logistic regression was used to quantify hospital-level and consultant-level variation in the proportion of cases performed by trainees.
RESULTS: Among 71 710 isolated AVR and 25 197 isolated MV surgery cases, 13 432 (18.7%) and 2472 (9.8%) were performed by trainees, respectively. MV surgery included 9893 MVR and 15 292 MVr, of which 1226 (12.4%) and 1246 (8.1%) were performed by trainees, respectively.Propensity matching generated balanced cohorts of 13 432 AVR, 1223 MVR and 1243 MVr pairs. Trainee-led procedures were not associated with higher in-hospital morbidity or mortality.Multilevel modelling demonstrated substantial variation in trainees being the primary operator, with 59.6%, 57.1% and 44.8% of variation at hospital-level and surgeon-level for AVR, MVr and MVR, respectively.
CONCLUSIONS: In this national UK cohort, trainees performed approximately one in five isolated AVR operations and one in ten isolated MV operations. Trainee exposure was the lowest in MVr. Trainee-led procedures were not associated with an increase in in-hospital mortality or early morbidity. There was a marked hospital-level and consultant-level variation in trainees' operating opportunities. These findings support continued structured exposure to isolated aortic and MV surgery, with particular attention to a specific MVr training pathway.
METHODS: All adults undergoing elective or urgent isolated AVR or isolated MVr/MVR in the National Adult Cardiac Surgery Audit between 1996 and 2019 were included. Temporal trends and early clinical outcomes were compared between consultants and trainees as primary operators. Three-level multilevel logistic regression was used to quantify hospital-level and consultant-level variation in the proportion of cases performed by trainees.
RESULTS: Among 71 710 isolated AVR and 25 197 isolated MV surgery cases, 13 432 (18.7%) and 2472 (9.8%) were performed by trainees, respectively. MV surgery included 9893 MVR and 15 292 MVr, of which 1226 (12.4%) and 1246 (8.1%) were performed by trainees, respectively.Propensity matching generated balanced cohorts of 13 432 AVR, 1223 MVR and 1243 MVr pairs. Trainee-led procedures were not associated with higher in-hospital morbidity or mortality.Multilevel modelling demonstrated substantial variation in trainees being the primary operator, with 59.6%, 57.1% and 44.8% of variation at hospital-level and surgeon-level for AVR, MVr and MVR, respectively.
CONCLUSIONS: In this national UK cohort, trainees performed approximately one in five isolated AVR operations and one in ten isolated MV operations. Trainee exposure was the lowest in MVr. Trainee-led procedures were not associated with an increase in in-hospital mortality or early morbidity. There was a marked hospital-level and consultant-level variation in trainees' operating opportunities. These findings support continued structured exposure to isolated aortic and MV surgery, with particular attention to a specific MVr training pathway.