Key result
Autonomous cardiac surgery by senior residents achieves comparable in-hospital and long-term survival to consultant-led cases.
Why the study?
Training challenges limit operative skill development, prompting evaluation of the safety of truly autonomous cardiac surgery performed by senior residents without direct consultant supervision.
Does truly autonomous senior resident-led cardiac surgery achieve comparable outcomes to consultant-led surgery in adult patients?
Cohort (n=1,606)
No
Does truly autonomous senior resident-led cardiac surgery achieve comparable outcomes to consultant-led surgery in adult patients?
Truly autonomous cardiac surgery by senior residents is safe and yields comparable early and long-term outcomes to consultant-led surgery in appropriately selected cases.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“It is worth noting that even when a resident doctor is 'leading' the surgery, the consultant is ultimately always in charge and responsible for the patient's care. The consultant is usually directly supervising, standing next to the resident, providing feedback and ready to step in at any point if patient safety is a concern. However, having the resident doing the operation makes a huge and positive impact on their training. There is nothing quite like hands-on training in a real-life scenario when it comes to cardiothoracic surgery.”
“Cardiac surgical training faces significant challenges. There are many contributing factors, including a reduced volume of surgical operations partly driven by increased transcatheter interventions (for example, TAVI for aortic valve stenosis), as well as increasingly complex cases, a patient population who increasingly have more comorbidities, and shorter mandated training programmes. Previously, cardiac surgical residents' training lasted more than 10 years. With the national standardisation of training curricula, this became eight years, and now seven years as of the 2021 curriculum. Then there is the European Working Time Directive, which is a good thing to prevent fatigue and burnout, but it does have an impact on exposure to surgery.”
Supports senior resident autonomy in cardiac surgery; extends safe training evidence amid declining caseloads.
Objectives Cardiac surgery demands substantial technical skill and intraoperative judgment. Residents must develop operative autonomy in preparation for independent consultant practice. However, current challenges, including working hour restrictions, shorter training programmes, reduced operative exposure, and increasing case complexity, limit opportunities for skill development. This study evaluated the safety of “truly autonomous” cardiac surgery performed by senior residents without direct consultant supervision. Methods Data for all adult cardiac surgeries between January 2015 and December 2024 were extracted from our institutional database. All resident-led cases undertaken without direct consultant supervision (Group R) were identified and 1:1 propensity-score matched with consultant-led cases (Group C) using the EuroSCORE II covariates. In-hospital outcomes (mortality, complications, length of stay) and long-term survival were compared. Results 16,945 procedures were undertaken during the study period. After applying inclusion/exclusion criteria, matching yielded 803 pairs, giving a study population of 1,606 patients. Groups had comparable demographics, preoperative characteristics, risk scores and bypass/cross-clamp times. Consultants undertook significantly more combined/aortic cases, with residents performing more isolated CABG/valve procedures. Groups had similar in-hospital outcomes and long-term survival. In a subgroup analysis of emergency operating, groups had similar outcomes. Conclusions Truly autonomous cardiac surgery by senior residents demonstrated comparable in-hospital and post-discharge outcomes to consultant-led cases. Even in emergency procedures, senior residents achieved comparable outcomes to matched consultant-led cases. Our study shows truly autonomous operating in appropriately selected cases to be feasible and safe, providing evidence-based justification for progressive independence in cardiac surgical training.
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Kumar et al. (2026) conducted a cohort in Adult cardiac surgery (n=1,606). Truly autonomous senior resident-led cardiac surgery vs. Consultant-led cardiac surgery was evaluated on In-hospital outcomes (mortality, complications, length of stay) and long-term survival. Truly autonomous cardiac surgery by senior residents (n=803) demonstrated comparable in-hospital and long-term survival outcomes to propensity-matched consultant-led cases (n=803).
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