Effect of training on patient outcomes following lobectomy.

BACKGROUND: Little is known about the effect of surgical training on outcomes in thoracic surgery. The impact of surgeon training on outcomes following lung resection was examined, focusing on lobectomy as a marker operation. METHODS: 328 consecutive patients who underwent lobectomy at our institution between 1 October 2001 and 30 June 2003 were studied. Data were collected prospectively during the patient's admission as part of routine clinical practice and validated by a designated audit officer. Patient characteristics and postoperative outcomes were compared between trainee led and consultant led operations. RESULTS: In 115 cases (35.1%) the operation was performed by a trainee thoracic surgeon as the first operator. There were no significant differences in patient characteristics between the two groups. In-hospital mortality was similar for operations led by trainees and consultants (3.5% and 2.8%, respectively; p > 0.99). Outcomes in the two groups did not differ significantly with respect to respiratory, cardiovascular, renal, neurological, chest infection, bleeding, and gastrointestinal complications. Survival rates at 1 year were 82.6% for procedures led by trainees compared with 81.7% for procedures led by consultants (p = 0.83). CONCLUSIONS: With appropriate supervision, trainee thoracic surgeons can perform lobectomies safely without compromising short or intermediate term patient outcome.

Conduction velocities of corticospinal axons in the rat studied by recording cortical antidromic responses.

The rat corticospinal tract was stimulated at the medullary pyramid and at different levels in the spinal cord (segments C2/3, T2, T12) and responses were recorded from the surface of the cerebral cortex and extracellularly from individual cortical neurones. Irrespective of the site stimulated, the earliest surface and single unit responses had frequency-following and other characteristics which indicated they resulted from antidromic invasion of corticospinal neurones. Synaptically mediated discharges with longer latency were also evoked in cortical neurones other than corticospinal neurones. At least in part these discharges probably resulted from stimulus spread to the dorsal column-medial lemniscus pathway. Corticospinal neurones were almost all between 1.0 and 1.5 mm beneath the cortical surface while synaptically excited units were at all depths greater than 0.4 mm. By stimulating at two sites, estimates of conduction velocity were obtained for single corticospinal axons. For those reaching at least as far as T12, velocities caudal to the pyramid ranged from 5 to 19 m/s (mean 11.4 +/- 2.9 m/s; S.D.). Slow axons in the pyramid (antidromic latency greater than 2.5 ms) could rarely be excited from T12. By stimulating at three sites (pyramid, T2, T12) most axons reaching T12 were found to have similar conduction velocities in the 'cervical' (pyramid-T2) and 'thoracic' (T2-T12) cord. However, in 15% of the axons the 'thoracic' velocity was at least 25% less than the cervical. The results are discussed and related to those from previous investigations.