Newly appointed surgeons were already highly skilled

In the British Medical Journal study about two deaths occurred for every 100 patients treated, regardless of the surgeon's experience.

This is reassuring news for patients say the Manchester University authors.

The rates were as good as any in the world and better than many, said a UK heart expert.

Mr Ben Bridgewater, cardiac surgeon at South Manchester University Hospital, and his colleagues traced the outcomes of 18,000 patients who underwent coronary artery surgery for the first time between 1997 and 2003.

These figures are superb Cardiothoracic surgeon Professor Tom Treasure

Of these, nearly 6,000 had been operated on by one of 15 'new' surgeons - surgeons who had been appointed as a consultant in the past four years.

The researchers compared the observed and predicted death rates for the new surgeons with the rates for the more established surgeons.

A total of 374 (2%) of the patients in the study died.

Comparing the rate for the two groups, 2% of the patients operated on by established surgeons and 1.9% of those operated on by new surgeons died.

Furthermore, among the newly appointed surgeons, death risk decreased as the surgeons became more experienced - from 2.2% during the first year to 1.2% during the fourth year in their role.

Patients and hospitals can be reassured that death is not higher in patients of newly appointed surgeons, the authors said.

Important findings

But there appeared to be a learning curve, which Dr Bridgewater's team said could be important if surgeons training times and working hours are reduced in the future under initiatives such as the European Working Time Directive.

They said their findings raised several questions that would need to be answered.

"While the effect for cardiac surgery seems to be marked, we do not know whether the learning curve is restricted to this specialty or whether it is seen in other surgical specialties or is a widespread phenomenon throughout medicine," they said.

It is not known whether structured supervision and training would speed up the learning curve, they added.

Professor Tom Treasure, cardiothoracic surgeon at Guy's and St Thomas' Hospital in London, said: "The survival rate is excellent for major heart surgery performed by these surgeons in the Manchester and Liverpool area.

"They are as good as any in the world and better than many.

"What they mean is that 49 out of 50 men and women having heart surgery go home alive to get the benefits.

"When you think that this includes all the operations including the elderly and the emergency cases or those who have had a recent heart attack, these figures are superb."