Boston - American Association for Thoracic Surgery

89 TH ANNUAL MEETING MAY 9–MAY 13, 2009BOSTON, MASSACHUSETTSL5. Quantitative Assessment of Technical Proficiency of Residentsin Cardiac SurgeryHiroo Takayama, Yoshifumi Naka, * Mehmet C. Oz, *† Allan S. Stewart,Mathew R. Williams, Craig R. Smith, * Micheal ArgenzianoColumbia University, New York, NY, USAOBJECTIVE: Board certification in cardiothoracic surgery requires that traineesperform of a minimum of 150 adult cardiac operations as “surgeon.” The aims ofthis study were to identify objective variables that correlated with residents’ technicalcompetence, and to determine the minimum number of operative casesrequired for residents to achieve acceptable proficiency.METHODS: The operative records of patients operated on by 12 consecutive residentsand fellows at our institution between 1/2002 and 6/2008 were retrospectivelyreviewed. This analysis included only cases done as “surgeon” by residents intheir final 9 months of training or during a 6 month post-residency fellowship.RESULTS: Over the 6.5 year study period, a total of 2919 cases were analyzed. Thisincluded 1146 isolated CABG, 944 aortic valve procedures (239 AVR+CABG, 220isolated AVR for AS, 110 AVR for AI, 375 other), 454 mitral valve procedures, 278heart transplants, 185 aortic operations, and 205 other procedures. Isolated AVR forAS (n = 220) was selected for further analysis due to its standardized operativetechnique and volume. The following variables were evaluated for suitability as asurrogate of surgical skill: aortic cross-clamp time (XCL), cardiopulmonary bypasstime, mortality, morbidity, PRBC transfusion requirement, hospital and ICUlength of stay. Among these, only XCL was significantly correlated to the operatingresident’s level of experience, with a progressive decrease in XCL (figure). Comparisonof this data to the XCL for isolated AVR for AS performed by a senior attendingsurgeon during the same period (57.2 ± 8 min) suggests that a minimum of 200cases would be required to achieve similar proficiency.CONCLUSION: XCL time for isolated AVR for AS is correlated to a resident’s surgicalexperience, and may be a reasonable surrogate of technical competence. Utilizingthis metric, it appears that more than 150 cases are required for residents toapproach the proficiency of an attending cardiac surgeon.* AATS Member† Robert E. Gross Research Scholarship 199462