Trainee surgeons and patient outcomes in carotid endarterectomy: a retrospective cohort study

Carotid endarterectomies are an essential part of the surgical management of embolic stroke prevention. Perioperative complication rates are pivotal in the justification of the procedure being performed. Through analysis of the Australasian Vascular Audit database, we found no significant difference...

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Bibliographic Details
Published in:	ANZ journal of surgery Vol. 90; no. 9; pp. 1710 - 1715
Main Authors:	Johnson, Nicholas W., Smoll, Nicholas R., Tan, Christianne, Brooks, Christopher E.
Format:	Journal Article
Language:	English
Published:	Melbourne John Wiley & Sons Australia, Ltd 01-09-2020 Blackwell Publishing Ltd
Subjects:	Australia - epidemiology carotid endarterectomy Carotid Stenosis - surgery Cohort analysis Confidence intervals Cranial nerves Data collection Endarterectomy, Carotid - adverse effects Humans Injuries Injury analysis Mortality Multivariate analysis New Zealand - epidemiology perioperative cranial nerve injury perioperative mortality perioperative stroke Retrospective Studies Risk Factors Skull Statistical analysis Stroke Stroke - epidemiology Stroke - etiology Surgeons Surgery surgical education surgical training Treatment Outcome vascular surgery New Zealand Australia perioperative stroke surgical training perioperative mortality carotid endarterectomy surgical education perioperative cranial nerve injury vascular surgery
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Summary:	Carotid endarterectomies are an essential part of the surgical management of embolic stroke prevention. Perioperative complication rates are pivotal in the justification of the procedure being performed. Through analysis of the Australasian Vascular Audit database, we found no significant difference in major patient morbidity or mortality in cases performed by an experienced vascular surgeon, and those cases with supervised trainees performing major components of the procedure. Background In Australia and New Zealand, more than 2000 carotid endarterectomies are performed annually. The major morbidities arising from this procedure are post‐operative stroke, cranial nerve injury and death. Carotid endarterectomy surgery is a key component of the vascular surgical training programme. We assessed the impact of having a surgical trainee perform a major component of this procedure on the post‐operative rates of stroke, cranial nerve injury and mortality. Methods We performed a retrospective cohort study of vascular surgical patients undergoing carotid endarterectomy, with data obtained from the Australasian Vascular Audit database between January 2010 and December 2014. The dataset comprised of 6528 carotid endarterectomies performed during this time. The collected data were stratified into two categories – consultant‐led cases, and those in which trainee surgeons performed at least a major component of the surgery under consultant supervision. The results were analysed for differences in post‐operative stroke, cranial nerve injury and inpatient mortality. Differences between groups were assessed using multivariate analysis, adjusting for potentially confounding covariables. Results On multivariate analysis, there was no statistically significant difference in the rates of post‐operative stroke (odds ratio (OR) 0.88, 95% confidence interval (CI) 0.57–1.36, P = 0.55), cranial nerve injury (OR 0.68, 95% CI 0.39–1.21, P = 0.19) or inpatient mortality (OR 0.78, 95% CI 0.29–2.13, P = 0.63) between the two cohorts. Conclusion Having surgical trainees perform components of carotid endarterectomies under supervision is not associated with an increased rate of post‐operative stroke, cranial nerve injury or mortality.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1445-1433 1445-2197
DOI:	10.1111/ans.16209