This week, the New England Journal of Medicine published the comparative effectiveness research trial "ROOBY" comparing conventional cardiac bypass surgery to off-pump bypass surgery. The study was conducted at VA medical centers and randomly enrolled 2203 patients between conventional bypass and off-pump bypass surgeries. The study concluded "At 1 year of follow-up, patients in the off-pump group had worse composite outcomes and poorer graft patency than did patients in the on-pump group. No significant differences between the techniques were found in neuropsychological outcomes or use of major resources." Excellent reviews of the trial (with associated surgeon commentary) are provided at theHeart.org and at MedPageToday.com.
What I found interesting was the fact that over half of the operations in the trial were performed by surgical residents. (Admitedly all surgeons had to have a minimum experience of 20 off-pump procedures, but the median off-pump experience by surgeons in the trial was 50 procedures.)
I wonder, where were the senior surgeons at the VA?