PMID- 3400061
OWN - NLM
STAT- MEDLINE
DCOM- 19880902
LR  - 20081121
IS  - 0039-6060 (Print)
IS  - 0039-6060 (Linking)
VI  - 104
IP  - 2
DP  - 1988 Aug
TI  - Operative mortality in patients undergoing single valve replacement in teaching 
      institutions--early mortality as a function of resident versus staff surgeon.
PG  - 301-10
AB  - Nine hundred sixty-four patients undergoing single valve replacement (SVR) 
      procedures alone or in combination with other cardiac surgical procedures were 
      analyzed prospectively to determine whether the risks of operative mortality (OM) 
      are different when the operation is performed by a resident under direct 
      supervision of an attending surgeon (group I, 49.5%) or by an attending surgeon 
      (group II, 50.5%). The overall OM rate was 8.4% (7.2% for group I and 9.7% for 
      group II, which was not significant). Fifty-eight clinical, angiographic, and 
      hemodynamic variables were analyzed to adjust statistically for differences in 
      patient characteristics in each group. For aortic valve replacement, group II 
      patients had smaller valve area and a higher incidence of three-vessel coronary 
      artery disease, and more patients required resection of an ascending aortic 
      aneurysm, whereas group I patients had higher incidence of peripheral edema and 
      S3 gallop. For mitral valve replacement, more patients in group II had pleural 
      effusion, previous cardiac operations, higher mean pulmonary artery pressures, 
      mitral insufficiency due to coronary artery disease, and were in New York Heart 
      Association (NYHA) functional class 3 and 4, whereas the group I patients had 
      higher incidence of S3 gallop and elevated serum creatinine. Expected OM for each 
      group was derived from a multivariate logistic model. Ratio of 
      observed-to-expected (O/E) OM was calculated to adjust observed OM according to 
      the risk of patients. There was no difference in O/E mortality ratio between the 
      two groups. We conclude that OM probability is not increased when the SVR 
      procedure is performed by residents under direct supervision of attending 
      surgeons when adjusted for patient- and disease-related risk factors. These 
      findings also constitute compelling evidence that patient care does not suffer 
      when resident teaching experience is enhanced in teaching institutions.
FAU - Sethi, G
AU  - Sethi G
AD  - Division of Cardiothoracic Surgery, VA Medical Center, Tucson, AZ.
FAU - Oprian, C
AU  - Oprian C
FAU - Miller, D C
AU  - Miller DC
FAU - Khuri, S
AU  - Khuri S
FAU - Cantor, A
AU  - Cantor A
FAU - Henderson, W G
AU  - Henderson WG
FAU - Hammermeister, K E
AU  - Hammermeister KE
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, U.S. Gov't, Non-P.H.S.
PL  - United States
TA  - Surgery
JT  - Surgery
JID - 0417347
SB  - IM
MH  - Aortic Valve/surgery
MH  - General Surgery
MH  - Heart Diseases/complications
MH  - Heart Valve Diseases/complications
MH  - Heart Valve Prosthesis/*mortality
MH  - Hospitals, Teaching
MH  - Humans
MH  - *Internship and Residency
MH  - *Medical Staff, Hospital
MH  - Middle Aged
MH  - Mitral Valve/surgery
MH  - Prospective Studies
MH  - Risk Factors
EDAT- 1988/08/01 00:00
MHDA- 1988/08/01 00:01
CRDT- 1988/08/01 00:00
PHST- 1988/08/01 00:00 [pubmed]
PHST- 1988/08/01 00:01 [medline]
PHST- 1988/08/01 00:00 [entrez]
PST - ppublish
SO  - Surgery. 1988 Aug;104(2):301-10.