Training in abdominal aortic aneurysm (AAA) repair: 1987-1997.
OBJECTIVE
in the U.K. a decrease in working hours has led to shortening of surgical training. Operative experience must, therefore, be gained more quickly. The aim of this study was to examine the effect of these changes in relation to outcome following abdominal aortic aneurysm (AAA) repair; a vascular "indicator" operation as defined by the U.K. Royal Colleges.


METHODS
analysis of a prospectively gathered database of 1136 consecutive elective and emergency AAA repairs. Two time periods, 1987-1991 and 1992-1997, are compared.


RESULTS
since 1991 consultants have performed fewer asymptomatic (95/130 vs. 135/244,p =0.0012, chi-square test), elective symptomatic (51/72 vs. 32/62, p =0.035), emergency symptomatic (33/49 vs. 38/82, p =0.031) and ruptured (173/229 vs. 160/268, p =0.0003) AAA repairs. This has been associated with a significant increase in the proportion of procedures where a trainee is assisted by a consultant or operates "solo". Operative mortality did not change significantly between the two time periods, and was not affected by the absence of a consultant from the operating table.


CONCLUSIONS
supervised trainees can perform an increasing proportion of AAA surgery without increasing operative mortality and can safely operate "solo" in selected cases. Auditing training in relation to clinical outcome is mandatory if the needs of patients and training surgeons are both to be met.
Evans
S M
SM
Vascular Surgery Unit, University Department of Clinical and Surgical Sciences, Royal Infirmary, Edinburgh, UK.
Adam
D J
DJ
Murie
J A
JA
Jenkins
A M
AM
Ruckley
C V
CV
Bradbury
A W
AW
D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000401:mortality / Q000601:surgery; D016009:Chi-Square Distribution; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D004630:Emergencies; D006801:Humans; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012606:Scotland / Q000453:epidemiology; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000193:education* / Q000706:statistics & numerical data