Effect of surgical training on outcome and hospital costs in coronary surgery

Background-There is a perceived conflict between the need for service provi sion and surgical training within the National Health Service (NHS). Traine e surgeons tend to be slower (thereby reducing theatre throughput), and may have more complications (increasing hospital stay and costs). Objective-To quantify the effect of training on outcome and costs. Design-Data on 2740 consecutive isolated coronary artery bypass (CABG) oper ations were analysed retrospectively. Redo and emergency procedures were ex cluded. The seniority of the operating surgeon was related to operating tim es, risk stratified outcome, and overall hospital costs. Setting-Regional cardiothoracic surgery unit. Main outcome measures-Postoperative mortality; hospital costs. Results-Consultants, senior trainees, intermediate trainees, and junior tra inees performed 1524, 759, 434, and 23 procedures, respectively. Trainees a t the three different levels were directly supervised by a consultant in 55 %, 95%, and 100% of cases. The unadjusted mortalities were 3.2%, 2.0%, 2.3% , and 4.3%, respectively (NS). There were no significant differences betwee n the groups with respect to time in the intensive care unit and length of hospital stay. The mean cost per patient was pound 6619, pound 6572, pound 6494, and pound 6404 (NS). Conclusions-Trainees performed 44.4% of all CABG operations. There was no d etrimental effect on patient outcome, length of hospital stay, or overall h ospital costs. There need be little conflict between service and training n eeds, even in hospitals with extensive training programmes.