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

Abstract Objectives Cardiac surgical training faces challenges including declining operative volumes, increasing case complexity, transcatheter interventions, and shorter training programmes. High-quality surgical training must not compromise patient safety. We assessed the impact of resident-led operating on outcomes in UK curriculum-defined adult cardiac surgical procedures. Methods Data for all adult cardiac surgeries performed between 2015 and 2024 were retrieved. Index procedures (isolated CABG, isolated AVR, CABG + AVR) were selected. 1:1 propensity-score matching of resident-led and consultant-led cases was performed. In-hospital outcomes (mortality, postoperative complications, duration of postoperative hospitalisation) and long-term survival were compared. Results 11,372 index procedures were undertaken. Matching yielded 4,259 pairs. Groups R (resident-led cases) and C (consultant-led cases) had similar demographics, preoperative cardiac function, functional status, medical history and operative risk scores. Consultants performed more combined procedures (18.2% vs 14.3%, p < 0.001). Cardiopulmonary bypass and aortic cross-clamp times were longer in group R (94 vs 89min and 60 vs 56min, both p < 0.001). In-hospital mortality was similar between groups. Higher deep sternal wound infection rates (1.2% [95% CI: 0.9-1.5] vs 0.7% [0.5-1.0], p = 0.033) and longer hospitalisations (7 [IQR 6-10] vs 6d [5-9], p < 0.001) were seen in group R. There was no statistically significant difference in long-term survival between groups (Group C HR 0.97 [95% CI: 0.88-1.07], p = 0.564). Conclusions Resident-led operating is safe in well-selected patients. Comparable mortality and morbidity suggest that well-supervised training does not compromise outcomes. These results support structured progressive autonomy in cardiac surgery training.