BACKGROUND: Thoracic procurements have traditionally been performed by surgical fellows or attending cardiothoracic surgeons. Donor lung procurement protocols are well established and fairly standardized; however, specific procurement training and judgment are essential to optimizing donor utilization. Although the predicted future deficits of cardiothoracic surgeons are based on a variety of analytic models and scenarios, it appears evident that there will not be a sufficient number of trained cardiothoracic surgeons over the next 2 decades. Over the past 5 years in our institution, lung procurements have been performed by a specifically trained physician assistant; as the lead donor surgeon. This model may serve as a cost effective, reproducible, and safe alternative to using surgical fellows and attending surgeons, assuring continuity, ongoing technical expertise, and teaching while addressing future workforce issues as related to transplant. METHODS: This is a single institution review of 287 consecutive lung procurements performed by either a physician assistant or fellow over 5 years. This study was approved by the Institutional Review Board of Columbia University, which waived the need for informed consent (IRB#AAAL7107). RESULTS: From 2008 to 2012, fellows served as senior surgeon in 90 cases (31.4%) versus 197 cases (68.6%) by the physician assistant, including 12 Donations after Cardiac Death and 6 reoperative donors. Injury rate was significantly lower for the physician assistant compared with the resident cohort (1 of 197 [0.5%] vs 22 of 90 [24%], respectively). Rates for pulmonary graft dysfunction grade 2 and 3 were found to be significantly lower in cases where the physician assistant served as senior surgeon (combined rates of 32.2% [29 of 90] vs 9.6% [19 of 197] in the physician assistant group) (p < 0.01). CONCLUSIONS: Use of experienced physician assistants in donor lung procurements is a safe and viable alternative offering continuity of technical expertise and evaluation of lung allografts.
BACKGROUND: Thoracic procurements have traditionally been performed by surgical fellows or attending cardiothoracic surgeons. Donor lung procurement protocols are well established and fairly standardized; however, specific procurement training and judgment are essential to optimizing donor utilization. Although the predicted future deficits of cardiothoracic surgeons are based on a variety of analytic models and scenarios, it appears evident that there will not be a sufficient number of trained cardiothoracic surgeons over the next 2 decades. Over the past 5 years in our institution, lung procurements have been performed by a specifically trained physician assistant; as the lead donor surgeon. This model may serve as a cost effective, reproducible, and safe alternative to using surgical fellows and attending surgeons, assuring continuity, ongoing technical expertise, and teaching while addressing future workforce issues as related to transplant. METHODS: This is a single institution review of 287 consecutive lung procurements performed by either a physician assistant or fellow over 5 years. This study was approved by the Institutional Review Board of Columbia University, which waived the need for informed consent (IRB#AAAL7107). RESULTS: From 2008 to 2012, fellows served as senior surgeon in 90 cases (31.4%) versus 197 cases (68.6%) by the physician assistant, including 12 Donations after Cardiac Death and 6 reoperative donors. Injury rate was significantly lower for the physician assistant compared with the resident cohort (1 of 197 [0.5%] vs 22 of 90 [24%], respectively). Rates for pulmonary graft dysfunction grade 2 and 3 were found to be significantly lower in cases where the physician assistant served as senior surgeon (combined rates of 32.2% [29 of 90] vs 9.6% [19 of 197] in the physician assistant group) (p < 0.01). CONCLUSIONS: Use of experienced physician assistants in donor lung procurements is a safe and viable alternative offering continuity of technical expertise and evaluation of lung allografts.
Authors: Marc de Perrot; Robert S Bonser; John Dark; Rosemary F Kelly; David McGiffin; Rebecca Menza; Octavio Pajaro; Stephan Schueler; Geert M Verleden Journal: J Heart Lung Transplant Date: 2005-08-08 Impact factor: 10.247
Authors: Mark L Barr; Steven M Kawut; Timothy P Whelan; Reda Girgis; Heidi Böttcher; Joshua Sonett; Wickii Vigneswaran; David M Follette; Paul A Corris Journal: J Heart Lung Transplant Date: 2005-07-27 Impact factor: 10.247
Authors: Selim M Arcasoy; Andrew Fisher; Ramsey R Hachem; Masina Scavuzzo; Lorraine B Ware Journal: J Heart Lung Transplant Date: 2005-10 Impact factor: 10.247
Authors: Ara A Vaporciyan; Carolyn E Reed; Clese Erikson; Michael J Dill; Andrea J Carpenter; Kristine J Guleserian; Walter Merrill Journal: J Thorac Cardiovasc Surg Date: 2009-05 Impact factor: 5.209
Authors: Jorge D Salazar; Peter Ermis; Antonio Laudito; Richard Lee; Grayson H Wheatley; Sean Paul; John Calhoon Journal: Ann Thorac Surg Date: 2006-09 Impact factor: 4.330