Training in Emergency Coronary Artery Bypass Grafting in the UK: Early Clinical Outcomes and Surgical Practice

Background: Little is known about the early clinical outcomes of patients undergoing emergency coronary artery bypass grafting (CABG) performed by cardiothoracic trainees. Method: All patients who underwent first-time, isolated emergency CABG in the United Kingdom between 1996 and April 2019 were identified from the National Adult Cardiac Surgery Audit database. Trends in surgical operator grade (trainee or consultant), early clinical outcomes, and the use of surgical techniques (on-pump versus off-pump) were evaluated. Results: A total of 7494 patients were included in the study. The median age was 67.9 years (interquartile range (IQR): 59.3–74.8), and 71% were male. Of these, 983 patients (13.1%) underwent emergency CABG performed by a surgeon in training. The proportion of emergency procedures performed by trainees fluctuated around 10% in 2000, decreased to 6.1% in 2002, and peaked at 20.6% in 2008. After propensity score matching, no differences were observed between trainees and consultants in mortality (9.3% vs. 7.1%; p = 0.073), incidence of return to theatre for bleeding (5.0% vs. 6.1%; p = 0.28), need for postoperative dialysis (6.2% vs. 7.4%; p = 0.39), deep sternal wound infection (0% vs. 1.3%; p = 0.26), or number of grafts (2.84% vs. 2.88%; p = 0.89). However, trainee-operated cases were associated with greater use of cardiopulmonary bypass (CPB) (92% vs. 87%; p < 0.001) and a higher incidence of postoperative cerebrovascular accident (5.3% vs. 2.1%; p = 0.009). Conclusion: Emergency CABG remains a high-risk operation with substantial in-hospital mortality. Trainees appear to have good exposure as first operators, with no increase in in-hospital mortality compared with consultants. However, trainees make more frequent use of CPB and have a significantly higher incidence of stroke.