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| Quantitative Assessment of Technical Proficiency of Residents in Cardiac Surgery | |
Hiroo Takayama, Yoshifumi Naka, Mehmet C. Oz, Allan S. Stewart, Mathew R. Williams, Craig R. Smith, Micheal Argenziano; Columbia University, New York, NY
Methods: The operative records of patients operated on by 12 consecutive residents and fellows at our institution between 1/2002 and 6/2008 were retrospectively reviewed. This analysis included only cases done as “surgeon” by residents in their 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. This included 1146 isolated CABG, 944 aortic valve procedures (239 AVR+CABG, 220 isolated AVR for AS, 110 AVR for AI, 375 other), 454 mitral valve procedures, 278 heart transplants, 185 aortic operations, and 205 other procedures. Isolated AVR for AS (n=220) was selected for further analysis due to its standardized operative technique and volume. The following variables were evaluated for suitability as a surrogate of surgical skill: aortic cross-clamp time (XCL), cardiopulmonary bypass time, mortality, morbidity, PRBC transfusion requirement, hospital and ICU length of stay. Among these, only XCL was significantly correlated to the operating resident’s level of experience, with a progressive decrease in XCL (figure). Comparison of this data to the XCL for isolated AVR for AS performed by a senior attending surgeon during the same period (57.2 ± 8 min) suggests that a minimum of 200 cases would be required to achieve similar proficiency. Conclusion: XCL time for isolated AVR for AS is correlated to a resident's surgical experience, and may be a reasonable surrogate of technical competence. Utilizing this metric, it appears that more than 150 cases are required for residents to approach the proficiency of an attending cardiac surgeon. 
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