THORACIC SURGERY

Effect of training on patient outcomes following lobectomy

N Chaudhuri¹, A D Grayson², R Grainger², N K Mediratta¹, M H Carr¹, A S Soorae¹, R D Page¹

¹ Department of Cardiothoracic Surgery, The Cardiothoracic Centre, Liverpool, UK
² Department of Clinical Governance, The Cardiothoracic Centre, Liverpool, UK

Correspondence to:
MrR D Page
The Cardiothoracic Centre, Liverpool L14 3PE, UK; richard.page{at}ctc.nhs.uk

Background: Little is known about the effect of surgical training on outcomes in thoracic surgery. The impact of surgeon training on outcomes following lung resection was examined, focusing on lobectomy as a marker operation.

Methods: 328 consecutive patients who underwent lobectomy at our institution between 1 October 2001 and 30 June 2003 were studied. Data were collected prospectively during the patient’s admission as part of routine clinical practice and validated by a designated audit officer. Patient characteristics and postoperative outcomes were compared between trainee led and consultant led operations.

Results: In 115 cases (35.1%) the operation was performed by a trainee thoracic surgeon as the first operator. There were no significant differences in patient characteristics between the two groups. In-hospital mortality was similar for operations led by trainees and consultants (3.5% and 2.8%, respectively; p>0.99). Outcomes in the two groups did not differ significantly with respect to respiratory, cardiovascular, renal, neurological, chest infection, bleeding, and gastrointestinal complications. Survival rates at 1 year were 82.6% for procedures led by trainees compared with 81.7% for procedures led by consultants (p = 0.83).

Conclusions: With appropriate supervision, trainee thoracic surgeons can perform lobectomies safely without compromising short or intermediate term patient outcome.

Abbreviations: CABG, coronary artery bypass grafting; COPD, chronic obstructive pulmonary disease; FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity

Keywords: training; lobectomy; mortality; morbidity; thoracic surgery

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