Patient outcomes following carotid endarterectomy are not adversely affected by surgical trainees’ operative involvement: A retrospective cohort study

Abstract

BackgroundSurgical training is an increasingly controversial topic. Concerns have been raised about both training opportunities becoming scarcer and poorer outcomes in operations led by surgical trainees; despite the evidence base for this being mixed. This retrospective cohort study aims to compare outcomes following carotid endarterectomy in patients who were operated on by a surgical trainee to those operated on by consultants.Materials and methodsConsecutive patients, who underwent carotid endarterectomy between 01/06/2012 and 1/12/2016, were entered into a prospectively maintained database. Patients were grouped according to whether a consultant or trainee vascular surgeon was the lead operating surgeon. Outcomes were 30-day mortality, 30-day stroke rate, operation time and complication rate.ResultsOne-hundred-and-twenty-one patients, with a mean age of 70.3 years, underwent carotid endarterectomy over a 4.5-year period. They were classified by the grade of the lead operating surgeon: consultant (n = 74) or registrar (n = 47). The median operative time was 117 min for consultants and 115 min for registrars with no significant difference between the two groups (p = 0.78). Three patients died in the post-op period, 2 secondary to post-operative stroke and a further 5 had nonfatal strokes. Grade of surgeon was also found to have no impact on 30- day mortality (p = 0.99) or stroke rate (p = 0.99). Sixty-six patients experienced post-operative complications, of varying severity, but no significant difference (p = 0.66) was found in incidence between trainee (57%) and consultant (53%) groups.ConclusionTrainee involvement in carotid endarterectomy, with consultant supervision, leads to equivalent outcomes and represents a safe and useful training opportunity.

Adverse events are not increased with trainee participation in transcarotid revascularization

“…[6][7][8] In one study evaluating CEAs, the authors found that trainee involvement in the operating room did not affect patient outcomes and mortality. 9 TCAR has recently emerged as a viable alternative for carotid revascularization due to its ability to provide neuroprotection during manipulation of the carotid artery. In the ROADSTER 2 trial, TCAR was found to have a high technical success rate, low perioperative stroke and death rates, as well as a lower risk of cranial nerve injury.…”

“…6–8 In one study evaluating CEAs, the authors found that trainee involvement in the operating room did not affect patient outcomes and mortality. 9…”