Resident versus attending surgeon graft patency and clinical outcomes in on- versus off-pump coronary artery bypass surgery

Veterans Affairs #517 Randomized On/Off Bypass (ROOBY) Study Group

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

OBJECTIVE: Controversy exists regarding ideal approaches in teaching residents complex and/or new surgical techniques in part because consequences on patient outcomes are largely unknown. This study compared patient outcomes for cases in which residents (rather than attending surgeons) performed most of the distal anastomoses as primary surgeons, during on- and off-pump coronary artery bypass grafting (CABG).

METHODS: This preapproved substudy of the Randomized On/Off Bypass (ROOBY) trial compared clinical outcomes and 1-year graft patency for cases in which residents versus attending surgeons were the primary operator. Comparisons were made between on-pump and off-pump techniques.

RESULTS: From July 2003 through May 2007, a total of 1272 ROOBY nonemergent CABG patients were randomized at 16 Veterans Affairs centers where residents were active participants. Residents were the primary surgeon (ie, performed ≥50% of the distal anastomoses) more frequently in on-pump (77.9%) than in off-pump (67.4%) cases. Between these 2 techniques, no were found differences in baseline patient characteristics; short-term and 1-year morbidity and mortality rates were no different for residents versus attendings in CABG cases. FitzGibbon A graft patency rates were similar for resident versus attendings completed distal anastomoses for on-pump (83.0% vs 82.4%) compared with off-pump (77.2% vs 76.6%) procedures.

CONCLUSIONS: In the ROOBY trial, short-term and 1-year patient outcomes and graft patency rates did not differ between resident and attending surgeons, demonstrating that with appropriate patient selection and resident supervision, residents can perform advanced, novel surgical techniques with outcomes similar to those of attending surgeons.

Original languageEnglish (US)
JournalJournal of Thoracic and Cardiovascular Surgery
Volume150
Issue number6
DOIs
StatePublished - Dec 1 2015

Fingerprint

Off-Pump Coronary Artery Bypass
Coronary Artery Bypass
Transplants
Veterans
Patient Selection
Surgeons
Teaching
Clinical Trials
Morbidity
Mortality

Keywords

  • CABG
  • education
  • graft patency
  • off-pump
  • on-pump
  • resident training

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Resident versus attending surgeon graft patency and clinical outcomes in on- versus off-pump coronary artery bypass surgery. / Veterans Affairs #517 Randomized On/Off Bypass (ROOBY) Study Group.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 150, No. 6, 01.12.2015.

Research output: Contribution to journalArticle

@article{f1f24c7df3884cb4bffd5d96432dc991,
title = "Resident versus attending surgeon graft patency and clinical outcomes in on- versus off-pump coronary artery bypass surgery",
abstract = "OBJECTIVE: Controversy exists regarding ideal approaches in teaching residents complex and/or new surgical techniques in part because consequences on patient outcomes are largely unknown. This study compared patient outcomes for cases in which residents (rather than attending surgeons) performed most of the distal anastomoses as primary surgeons, during on- and off-pump coronary artery bypass grafting (CABG).METHODS: This preapproved substudy of the Randomized On/Off Bypass (ROOBY) trial compared clinical outcomes and 1-year graft patency for cases in which residents versus attending surgeons were the primary operator. Comparisons were made between on-pump and off-pump techniques.RESULTS: From July 2003 through May 2007, a total of 1272 ROOBY nonemergent CABG patients were randomized at 16 Veterans Affairs centers where residents were active participants. Residents were the primary surgeon (ie, performed ≥50{\%} of the distal anastomoses) more frequently in on-pump (77.9{\%}) than in off-pump (67.4{\%}) cases. Between these 2 techniques, no were found differences in baseline patient characteristics; short-term and 1-year morbidity and mortality rates were no different for residents versus attendings in CABG cases. FitzGibbon A graft patency rates were similar for resident versus attendings completed distal anastomoses for on-pump (83.0{\%} vs 82.4{\%}) compared with off-pump (77.2{\%} vs 76.6{\%}) procedures.CONCLUSIONS: In the ROOBY trial, short-term and 1-year patient outcomes and graft patency rates did not differ between resident and attending surgeons, demonstrating that with appropriate patient selection and resident supervision, residents can perform advanced, novel surgical techniques with outcomes similar to those of attending surgeons.",
keywords = "CABG, education, graft patency, off-pump, on-pump, resident training",
author = "{Veterans Affairs #517 Randomized On/Off Bypass (ROOBY) Study Group} and Almassi, {G. Hossein} and Carr, {Brendan M.} and Muath Bishawi and Shroyer, {A. Laurie} and Quin, {Jacquelyn A.} and Brack Hattler and Wagner, {Todd H.} and Collins, {Joseph F.} and Pasala Ravichandran and Cleveland, {Joseph C.} and Grover, {Frederick L.} and Bakaeen, {Faisal G.}",
year = "2015",
month = "12",
day = "1",
doi = "10.1016/j.jtcvs.2015.08.124",
language = "English (US)",
volume = "150",
journal = "Journal of Thoracic and Cardiovascular Surgery",
issn = "0022-5223",
publisher = "Mosby Inc.",
number = "6",

}

TY - JOUR

T1 - Resident versus attending surgeon graft patency and clinical outcomes in on- versus off-pump coronary artery bypass surgery

AU - Veterans Affairs #517 Randomized On/Off Bypass (ROOBY) Study Group

AU - Almassi, G. Hossein

AU - Carr, Brendan M.

AU - Bishawi, Muath

AU - Shroyer, A. Laurie

AU - Quin, Jacquelyn A.

AU - Hattler, Brack

AU - Wagner, Todd H.

AU - Collins, Joseph F.

AU - Ravichandran, Pasala

AU - Cleveland, Joseph C.

AU - Grover, Frederick L.

AU - Bakaeen, Faisal G.

PY - 2015/12/1

Y1 - 2015/12/1

N2 - OBJECTIVE: Controversy exists regarding ideal approaches in teaching residents complex and/or new surgical techniques in part because consequences on patient outcomes are largely unknown. This study compared patient outcomes for cases in which residents (rather than attending surgeons) performed most of the distal anastomoses as primary surgeons, during on- and off-pump coronary artery bypass grafting (CABG).METHODS: This preapproved substudy of the Randomized On/Off Bypass (ROOBY) trial compared clinical outcomes and 1-year graft patency for cases in which residents versus attending surgeons were the primary operator. Comparisons were made between on-pump and off-pump techniques.RESULTS: From July 2003 through May 2007, a total of 1272 ROOBY nonemergent CABG patients were randomized at 16 Veterans Affairs centers where residents were active participants. Residents were the primary surgeon (ie, performed ≥50% of the distal anastomoses) more frequently in on-pump (77.9%) than in off-pump (67.4%) cases. Between these 2 techniques, no were found differences in baseline patient characteristics; short-term and 1-year morbidity and mortality rates were no different for residents versus attendings in CABG cases. FitzGibbon A graft patency rates were similar for resident versus attendings completed distal anastomoses for on-pump (83.0% vs 82.4%) compared with off-pump (77.2% vs 76.6%) procedures.CONCLUSIONS: In the ROOBY trial, short-term and 1-year patient outcomes and graft patency rates did not differ between resident and attending surgeons, demonstrating that with appropriate patient selection and resident supervision, residents can perform advanced, novel surgical techniques with outcomes similar to those of attending surgeons.

AB - OBJECTIVE: Controversy exists regarding ideal approaches in teaching residents complex and/or new surgical techniques in part because consequences on patient outcomes are largely unknown. This study compared patient outcomes for cases in which residents (rather than attending surgeons) performed most of the distal anastomoses as primary surgeons, during on- and off-pump coronary artery bypass grafting (CABG).METHODS: This preapproved substudy of the Randomized On/Off Bypass (ROOBY) trial compared clinical outcomes and 1-year graft patency for cases in which residents versus attending surgeons were the primary operator. Comparisons were made between on-pump and off-pump techniques.RESULTS: From July 2003 through May 2007, a total of 1272 ROOBY nonemergent CABG patients were randomized at 16 Veterans Affairs centers where residents were active participants. Residents were the primary surgeon (ie, performed ≥50% of the distal anastomoses) more frequently in on-pump (77.9%) than in off-pump (67.4%) cases. Between these 2 techniques, no were found differences in baseline patient characteristics; short-term and 1-year morbidity and mortality rates were no different for residents versus attendings in CABG cases. FitzGibbon A graft patency rates were similar for resident versus attendings completed distal anastomoses for on-pump (83.0% vs 82.4%) compared with off-pump (77.2% vs 76.6%) procedures.CONCLUSIONS: In the ROOBY trial, short-term and 1-year patient outcomes and graft patency rates did not differ between resident and attending surgeons, demonstrating that with appropriate patient selection and resident supervision, residents can perform advanced, novel surgical techniques with outcomes similar to those of attending surgeons.

KW - CABG

KW - education

KW - graft patency

KW - off-pump

KW - on-pump

KW - resident training

UR - http://www.scopus.com/inward/record.url?scp=84960963997&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84960963997&partnerID=8YFLogxK

U2 - 10.1016/j.jtcvs.2015.08.124

DO - 10.1016/j.jtcvs.2015.08.124

M3 - Article

C2 - 26470910

AN - SCOPUS:84960963997

VL - 150

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

SN - 0022-5223

IS - 6

ER -