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Surgical Teaching Predicts ICU Length of Stay in CABG Surgery
T. M. Yau, M. A. Borger, S. J. Brister, M. Maganti, V. Rao. Toronto General Hospital, Toronto, ON, Canada,
BACKGROUND: We evaluated the effect of operation by attending surgeons versus fellows (board-certified surgeons with limited operative experience) on the outcomes and resource utilization of CABG.
METHODS: Data gathered prospectively on 1171 patients in the practice of 3 attending surgeons over a 3 year period were evaluated by multivariable analyses. Patients were managed in the ICU by intensivists unaware of attending surgeon versus fellow operative responsibility.
RESULTS: 442 patients were operated on by fellows, and 729 by attending surgeons. Patients operated on by attending surgeons had a significantly greater risk profile and received more grafts per patient (p=0.05). Aortic crossclamp, bypass and operative times were longer in operations performed by fellows (p<0.05).
Mortality (1.1% vs. 0.9%), perioperative infarction, stroke, resternotomy and sternal infection were similar between groups, and multivariable regression revealed no effect of a fellow operating.
In contrast, by multivariable linear regression, operation by a fellow increased duration of ventilation by 9+5 hrs (p=0.06) and ICU length of stay by 12+6 hrs (p=0.048). Redo surgery (+3+19 hrs), peripheral vascular disease (+12+8 hrs) and a recent MI (+7+8 hrs) had less effect on ICU stay (p=NS) than did operation by a fellow, while diabetes (+17+6 hrs), COPD (+36+13 hrs) and heart failure (+37+11 hrs) had greater effects (p<0.05).
CONCLUSIONS: Patients operated on by fellows have morbidity and mortality equivalent to those achieved by attending surgeons, but utilize significantly more resources. This effect should be recognized as an implicit component of our responsibility to train future cardiothoracic surgeons.
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