title: Is carotid endarterectomy a trainee operation?
abstract: BACKGROUND
  Recent dramatic changes in surgical training resulting from working-hour regulations may lead to lack of competence. Traditionally, carotid surgery has been the domain of specialists. This study was designed to compare the outcome of carotid endarterectomy performed by vascular surgical trainees versus vascular surgeon (VS).
  
  
  METHODS
  A retrospective study of 1,379 consecutive patients who underwent carotid endarterectomy as the sole procedure under local or general anesthesia (from 1995-2004) was performed. All patients were admitted to the intensive care unit for 24 hours. Trainees performed 475 (34.5%) and vascular specialists performed 904 (65.5%) operations.
  
  
  RESULTS
  Patient characteristics with regard to preoperative neurological status were similar. Trainees operated on 61.4% symptomatic patients and VS on 56.8% (P = 0.09). Shunt use did not differ (16% trainee vs. 17.8% VS). Clamping time and total operating time were longer among trainees (41.9 vs. 33.5 min, P < 0.001; and 121.2 vs. 101.8 min, P < 0.001, respectively). Postoperative stroke and death rates (3.2% vs. 3.1% and 0.4% vs. 0.9%, respectively) did not differ. Peripheral nerve complications were more common among trainees (12.2% vs. 6.5%; P < 0.0001); 99.6% of these nerve injuries had resolved at 3 months' follow-up.
  
  
  CONCLUSIONS
  Carotid endarterectomy can be performed safely by a trainee vascular surgeon when assisted and supervised by a specialist vascular surgeon.
authors.affiliation: Department of Vascular Surgery, Städtisches Klinikum, Dessau, Germany. hans-joachim.lutz@marienhospital-hamm.de
authors.forename: Hans-Joachim
authors.initials: HJ
authors.lastname: Lutz
authors.forename: R
authors.initials: R
authors.lastname: Michael
authors.forename: B
authors.initials: B
authors.lastname: Gahl
authors.forename: H
authors.initials: H
authors.lastname: Savolainen
mesh_terms: D000368:Aged; D016893:Carotid Stenosis / Q000601:surgery*; D016009:Chi-Square Distribution; D002983:Clinical Competence; D016894:Endarterectomy, Carotid / Q000592:standards*; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male