Impact of Resident-Led Operating on Outcomes in Adult Cardiac Surgery: A 10-Year Propensity-Matched Analysis

This 10-year, single-center, propensity-matched study compared the outcomes of resident-led operations with those of consultant-led operations at a high-volume UK center. This study investigated index adult cardiac surgical procedures as defined in the UK training curriculum, specifically isolated coronary artery bypass grafting (CABG), isolated aortic valve replacement (AVR), and combined CABG and AVR. Of a total of 11,372 such procedures performed between 2015 and 2024, propensity matching yielded 4,259 pairs for analysis (n = 8,518). 
 
Despite longer cardiopulmonary bypass and aortic cross-clamp times in resident-led cases, the groups had a higher incidence of deep sternal wound infection (1.2 percent vs 0.7 percent, p = 0.033) and a one-day longer median hospital stay (seven vs six days, p < 0.001). However, they exhibited comparable in-hospital mortality and rates of other postoperative complications, as well as comparable long-term survival extending to 10 years. Subgroup analyses demonstrated comparable morbidity, mortality, and long-term survival across each index procedure type. 
 
These findings provide reassurance for current cardiac surgical training models, indicating that a supervised, stepwise increase in residents’ operative responsibility can be implemented safely despite persistent scrutiny of outcomes and ongoing constraints on training time and operative exposure. By focusing on curriculum-defined index procedures, the study supports the safe incorporation of progressive operative autonomy within structured training programs without adversely affecting patient outcomes.