Abstract
Background Recent dramatic changes in surgical training resulting from working-hour regulations may lead to lack of competence. Traditionally,
carotid surgery has been the domain of specialists. This study was designed to compare the outcome of carotid endarterectomy
performed by vascular surgical trainees versus vascular surgeon (VS).
Methods A retrospective study of 1,379 consecutive patients who underwent carotid endarterectomy as the sole procedure under local
or general anesthesia (from 1995?2004) was performed. All patients were admitted to the intensive care unit for 24 hours.
Trainees performed 475 (34.5%) and vascular specialists performed 904 (65.5%) operations.
Results Patient characteristics with regard to preoperative neurological status were similar. Trainees operated on 61.4% symptomatic
patients and VS on 56.8% (
P = 0.09). Shunt use did not differ (16% trainee vs. 17.8% VS). Clamping time and total operating time were longer among trainees
(41.9 vs. 33.5 min,
P < 0.001; and 121.2 vs. 101.8 min,
P < 0.001, respectively). Postoperative stroke and death rates (3.2% vs. 3.1% and 0.4% vs. 0.9%, respectively) did not differ.
Peripheral nerve complications were more common among trainees (12.2% vs. 6.5%;
P < 0.0001); 99.6% of these nerve injuries had resolved at 3 months? follow-up.
Conclusions Carotid endarterectomy can be performed safely by a trainee vascular surgeon when assisted and supervised by a specialist
vascular surgeon.
- Content Type Journal Article
- DOI 10.1007/s00268-008-9822-3
- Authors
- Hans-Joachim Lutz, Städtisches Klinikum Department of Vascular Surgery Dessau Germany
- R. Michael, Städtisches Klinikum Department of Vascular Surgery Dessau Germany
- B. Gahl, University Hospital Bern Department of Cardiovascular Surgery, Swiss Cardiovascular Centre Bern Switzerland
- H. Savolainen, University Hospital Bern Department of Cardiovascular Surgery, Swiss Cardiovascular Centre Bern Switzerland
Original source: http://www.springerlink.com/content/q3g7007762397040/
