title: Arteriovenous fistula formations: key to vascular surgical training.
abstract: OBJECTIVE
  To highlight missed training opportunities in daycase surgery for trainees to acquire competency in vascular anastomosis by performing arteriovenous fistula (AVF) formations.
  
  
  METHODS
  Operative Room Management Information System records were reviewed for AVF procedures in daycase and general theatres at a UK Foundation Trust between 2007 and 2012. Data collected included procedure, procedure time (PT), patient length of stay (LOS), readmissions within 30 days of procedure and lead and assistant surgeons involved.
  
  
  RESULTS
  Of 199 daycase AVF procedures reviewed, 59.3% (n=118) were brachiocephalic formations and 34.2% (n=68) radiocephalic formations. Trainees attended 41.2% of daycase AVF procedures and were lead surgeon in 7.3% of these. Mean PT was 64 minutes for consultants compared with 56 minutes for trainees, with no significant difference (p=0.297). Median patient LOS was less than 24 hours for both groups. Six daycase AVF procedures resulted in patient readmission within 30 days; five of these were operated on by consultants and one by a staff grade. During the same period, 258 AVF procedures were performed in general theatres. Trainees attended 64.3% of AVF formations performed in general theatres and were lead surgeon in 5.8% of these.
  
  
  CONCLUSIONS
  Trainees attended and led few daycase AVF formations despite no significant difference in PT, patient LOS or readmission rate between consultant-led and trainee-led cases. Trainees attended more AVF formations performed in general theatres than daycase. However, trainees led a greater proportion of daycase AVF formations, possibly due to a less complex case mix that is more suitable for training.
authors.affiliation: Daycase Unit Department of Surgery, Royal Derby Hospitals Foundation Trust, Derby - UK.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: El-Sharkawy
authors.forename: Daniel L J
authors.initials: DL
authors.lastname: Morris
authors.forename: Balvinder S
authors.initials: BS
authors.lastname: Grewal
authors.forename: John W
authors.initials: JW
authors.lastname: Quarmby
authors.forename: Timothy E
authors.initials: TE
authors.lastname: Rowlands
mesh_terms: D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000193:education*; D002983:Clinical Competence; D003479:Curriculum; D004503:Education, Medical, Graduate / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D009870:Operating Room Information Systems; D061646:Operative Time; D010359:Patient Readmission; D012189:Retrospective Studies; D013663:Teaching / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom