Can We Safely Train Cardiothoracic Surgical Residents to Perform Emergency Surgery? A 10-Year Propensity-Matched Analysis.

OBJECTIVES: Cardiac surgical training in the current era faces significant challenges, including working time restrictions, increasing case complexity, and shorter training programmes. Ensuring high-quality training without compromising patient safety is critical, particularly in the emergency setting. We compared outcomes between resident and consultant-led emergency cardiac surgery. METHODS: Data for all emergency adult cardiac surgical procedures performed between 2015 and 2024 were retrieved from our institutional database and the UK National Mortality database was queried for the relevant patients. 1:1 propensity-score matching of resident-led (group R) and consultant-led cases (group C) was performed. In-hospital outcomes (mortality, established postoperative complications, duration of postoperative hospitalization) and post-discharge outcomes (long-term survival) were compared. RESULTS: A total of 1241 emergency procedures were undertaken at our institution during the study period. Propensity-score matching yielded 364 matched pairs. Groups R and C had comparable demographics, preoperative characteristics, and risk scores. Cardiopulmonary bypass and aortic cross-clamp times were longer in group C (148 vs 122 min, P = .004 and 78 vs 69 min, P = .068), possibly reflecting more complex cases. There were no significant differences between groups in the in-hospital and post-discharge outcomes. CONCLUSIONS: Supervised resident-led emergency cardiac surgery achieves outcomes comparable to consultant-led procedures. These findings support supervised exposure to emergency cardiac surgery with progressive autonomy, ensuring patient safety while preparing residents for independent practice.