Risk stratification for training in cardiac surgery

Background: There is a potential conflict of interest in providing the best possible outcome for patients undergoing cardiac surgery and good training for junior cardiac surgeons. Methods: We analysed training with reference to volume of work, risk stratification and outcome for consultant and train ee procedures. The Parsonnet system was used For risk stratification. A ret rospective audit was performed for a 6-year period. Results: During the stu dy period, 6037 operations were performed, of which 2166 were carried out b y trainees. Direct consultant assistance in a trainee operation varied betw een 17% and 51% and increased towards the end of the study period. Of the o perations performed by trainees, 88% were CABG. The median Parsonnet score for consultant operations was 9 compared with 4 for trainees. Actual mortal ity was below predicted for all surgeons. Morbidity was also lowest for tra inees (10%). Conclusions: With appropriate case selection, trainees in card iac surgery can achieve good results. As training changes in the UK, traine es should receive increased supervised exposure to a wider range of procedu re to compensate for a lower volume of workload.