Vascular training does matter in the outcomes of saphenous high ligation and stripping

Abstract

Objective: Varicose vein (VV) surgery is frequently performed by surgeons without formal vascular training. We aimed to compare the outcomes of the procedure based on the background of the surgeon.Methods: All patients registered with VV surgery between 2004 and 2016 in Portuguese public hospitals were included in the study. Intrahospital outcomes were assessed from this administrative database. A random multicenter sample of 315 patients submitted to saphenous high ligation and stripping (175 patients from six vascular surgery departments and 140 patients from five general surgery divisions) were further queried over the phone, whereby additional nonregistered outcomes were evaluated: preoperative venous ultrasound, impact on quality of life by the 14-item Chronic Venous Insufficiency Quality of Life Questionnaire, visual analogue scale evaluation (score of 1 to 5) of the aesthetic results and general satisfaction, work absence days, and time to return to physical activities.Results: In 13 years, there were 153,382 patients submitted to VV surgery. Of these, 49% were operated on by general surgeons and 40% by vascular surgeons; in 11%, it was not possible to identify the specialty performing the operation. Twenty-three deaths were registered (no differences between groups). In the general surgery group, 14% of patients were hospitalized for more than one night compared with 3% in the vascular group (P < .001). Reintervention rate during the period analyzed was significantly higher in the general surgery group (13.5% vs 8.2%; P < .001). Rate of outpatient surgery was higher in the vascular surgery group (60% vs 36%; P < .001). Phone query revealed similar overall satisfaction and improvement in quality of life in both groups (4.2 vs 4.0 [P ¼ .275] and 35% vs 36% [P ¼ .745], respectively). However, patients operated on by general surgeons reported worse surgical scars (2.8 vs 2.1; P ¼ .007), higher number of residual VVs (2.4 vs 1.7; P ¼ .006), and higher number of days absent from work (40 vs 27 days; P ¼ .005) and took longer to resume physical activities (60 vs 41 days; P ¼ .001).Conclusions: Despite that the majority of VV surgery in Portugal is executed by general surgeons, this study highlights important advantages when it is performed by surgeons with vascular training.

Epidemiology of 869,220 varicose vein surgeries over 12 years in Brazil: trends, costs and mortality rate

“…After the 869,220 surgeries performed to treat CVD, we observed 49 deaths within the index admission in the hospital or in the outpatient facility, corresponding to a mortality rate of 0.0056%. To our knowledge, the only other population-based study for comparison was the one evaluating the data from Portuguese public hospitals, with an inhospital mortality rate of 0.015% 20 . The mortality rate for CVD surgeries in Portugal was three-fold higher.…”

“…In the USA, a total of 48,615 surgeries for CVD was performed between 2005 and 2017, with a 30-day mortality rate of 0.02% 19 . In Portugal, 153,382 patients underwent surgery to treat CVD in public hospitals between 2004 and 2016, with an in-hospital mortality rate of 0.015% 20 .…”

Epidemiology of 869,220 varicose vein surgeries over 12 years in Brazil: trends, costs and mortality rate

“…This finding underlines the safety of the surgical treatment. To our knowledge, the only other population-based study for comparison was the one evaluating the data from Portuguese public hospitals, with an in-hospital mortality rate of 0.015% [22]. The other population-based studies that assessed deaths following CVD surgeries evaluated 30-day mortality [20,21].…”

“…In the USA, according to the American College of Surgeons -Quality Improvement Program [21], a total of 48,615 surgeries for CVD was performed between 2005 and 2017, with a 30-day mortality rate of 0.02%. In Portugal, 153,382 patients underwent surgery to treat CVD in public hospitals between 2004 and 2016, with an in-hospital mortality rate of 0.015% [22]. We believe that only population-level data generate real-world evidence, better supporting the health care.…”

Efficacy and safety of endovenous microwave ablation versus laser ablation for great saphenous vein varicosis: study protocol for a multicentre, randomised controlled non-inferiority trial

“…The common conventional surgical treatment for GSV varicosis is high ligation and stripping (HLS), but it has been reported to cause high postoperative clinical recurrence, slow recovery and obvious incision scar 4 5. Because of the need of less invasive treatment, endovenous thermal ablation techniques, such as radiofrequency ablation (RFA) and endovenous laser ablation (EVLA), have been developed 6 7.…”