A. A. Haider2, A. Azim2, M. Bravo2, R. Latifi2, J. Goldberg2 2New York Medical College,Department Of Surgery,Valhalla, NY, USA
Introduction: Surgical residents and medical student play a major role in patient care at teaching hospitals with varying degrees of involvement. It is often feared that trainee involvement in patient care may adversely affect clinical outcomes. The effect of trainee involvement on patient clinical outcomes after major cardiac procedures remain unknown. The aim of our study was to evaluate if trainee involvement in major cardiac surgery such as coronary artery bypass graft (CABG) is associated with worse outcomes.
Methods: The National Inpatient Sample was abstracted for 3 years for all patients (≥18 years) who underwent CABG. Data was abstracted for patient demographics (age and gender), disease severity, co-morbidities, nature of admission (elective versus emergent), and hospital volumes (low, medium, and high). Patients were divided into two groups: Teaching hospital (TH) and non-teaching hospitals (non-TH). Outcome measures were mortality and failure-to-rescue (death after a complication). Multivariate logistic regression analysis was performed.
Results: A total of 141,392 patients from 589 hospitals were included. Mean age was 65.9 ± 10.8 years, 72.3% were male, and mean Charlson Comorbidity Index was 1.39 ±1.42. 58.1% (n=80,688) patients were treated at TH and 41.9% (n= 58,128) were treated at non-TH. Overall mortality rate in the population was 2.5 % and failure-to-rescue rate was 2.1%. Unadjusted mortality rate (2.6% vs. 2.4%; p=0.04) and FTR (2.1% vs. 2.0%; p=0.04) at TH was higher compared to non teaching. However, after adjusting for confounders with multivariate regression analysis, the odds of mortality (OR: 1.02; CI: 0.95- 1.10) and FTR (OR: 1.02 ; CI: 0.94-1.11) were similar between TH and non-TH.
Conclusion: Unadjusted rates of mortality and failure to rescue at teaching hospitals are slightly higher compared to non-teaching hospitals. This difference may likely be due to difference in disease severity and hospital volume as this effect disappears after adjusting for these factors. With adequate supervision, teaching hospitals can achieve similar outcomes to non-teaching hospitals after major cardiac procedures such as CABG.