Provision of training in carotid surgery does not compromise patient safety.
BACKGROUND
Vascular surgeons perceive that carotid endarterectomy carries a higher risk of stroke if performed by a surgical trainee. Accordingly, some trainees consider that they receive a less than adequate training in carotid surgery before taking up a consultant position. The aim of this study was to establish whether the stroke rate was adversely affected if carotid endarterectomy was performed by a surgical trainee under consultant supervision.


METHODS
This was a prospective study of 151 consecutive patients undergoing carotid endarterectomy between 1 January and 31 December 1996 using a standardized technique including intraoperative and postoperative transcranial Doppler monitoring and completion angioscopy.


RESULTS
The overall mortality and/or disabling stroke rate was 0.7 per cent (one of 151 patients), whereas the mortality and/or any stroke rate was 1.3 per cent (two of 151). Surgical trainees performed 82 of 151 carotid endarterectomies, with a mortality rate of 1 per cent and a mortality and/or any stroke rate of 2 per cent. There was no significant difference in the incidence of retained thrombus or intimal flaps between trainees and consultants as detected by angioscopy.


CONCLUSIONS
Vascular surgical trainees can receive a comprehensive training in carotid artery surgery without incurring an unacceptable increase in operative risk.
Department of Surgery, Leicester Royal Infirmary, UK.
A R
AR
Naylor
M M
MM
Thompson
K
K
Varty
R D
RD
Sayers
N J
NJ
London
P R
PR
Bell
D000368:Aged; D002561:Cerebrovascular Disorders / Q000209:etiology*; D003253:Consultants; D004503:Education, Medical, Graduate; D016894:Endarterectomy, Carotid / Q000401:mortality / Q000592:standards; D006801:Humans; D007430:Intraoperative Care / Q000592:standards; D008505:Medical Staff, Hospital / Q000193:education*; D011446:Prospective Studies; D011786:Quality Control; D012449:Safety