Cacioppa Laura Maria, Pini Rodolfo, Longhi Matteo, Vacirca Andrea, Gallitto Enrico, Faggioli Gianluca, Gargiulo Mauro, Stella Andrea
Vascular Surgery Unit, Dipartimento di Medicina Specialistica Diagnostica e Sperimentale (DIMES), Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy.
Vascular Surgery Unit, Dipartimento di Medicina Specialistica Diagnostica e Sperimentale (DIMES), Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy.
Ann Vasc Surg. 2018 Feb;47:195-199. doi: 10.1016/j.avsg.2017.08.024. Epub 2017 Sep 7.
Carotid endarterectomy (CEA) intervention needs a specific training and a sufficient learning curve to obtain optimal results in terms of outcome. A formative program was settled up in a single academic center to optimize training of standard CEA procedures. This study aims to evaluate the 11-year results of the teaching CEA program.
The trainees CEA teaching program is carried on during the 5-year vascular surgery residency period, and it is stratified as follows: learning theory and intervention assistance (minimum 50 procedures per year) in the first and second residency year; performing CEA as second operator in the third and fourth residency year (minimum 50 procedures per year); CEA execution as first operator with attending supervision in the last residency year. All CEA procedures from 2005 to 2015 were retrospectively collected and the 30-day results were compared according to the expertise of the first operator: experienced vascular surgeons (EVSs) versus trainees. All CEA procedures were performed in general anesthesia, with routine shunting and patching.
In the study period, 1,379 (361 [26.2%] symptomatic; 1,018 [73.8%] asymptomatic) CEAs were performed. Trainees performed 199 (14.4%) CEAs as first operator. Patients submitted to CEA by trainees were similar in terms of preoperative clinical characteristics except for the patients' age (trainees 72.4 years versus EVS 70.8 years, P = 0.02) and smoking history (trainees 30.7% versus EVS 24.1%, P = 0.04). The 30-day complication rates were similar in CEA performed by trainees versus EVS: stroke 0.5% vs. 1.1%, P = 0.5; death 0.0% vs. 0.5%, P = 0.6; stroke/death 0.5% vs. 1.7%, P = 0.24; hematoma 3.0% vs. 2.2%, P = 0.48; and cranial nerve injury 9.0% vs. 7.8%, P = 0.47, respectively. The intervention time was significantly longer in CEAs performed by trainees compared with EVS: 104 ± 1.9 min versus 98 ± 1.0 min, P = 0.02.
With a defined CEA teaching program, trainees can obtain results similar to those of more experienced surgeons in terms of clinical outcome at the price of an increased intervention time.
颈动脉内膜切除术（CEA）干预需要特定的培训和足够的学习曲线，以在治疗效果方面获得最佳结果。在一个单一的学术中心设立了一个形成性项目，以优化标准CEA手术的培训。本研究旨在评估CEA教学项目11年的成果。
学员CEA教学项目在5年的血管外科住院医师培训期间进行，分层如下：在住院医师培训的第一年和第二年学习理论并协助干预（每年至少50例手术）；在住院医师培训的第三年和第四年作为第二术者进行CEA手术（每年至少50例手术）；在住院医师培训的最后一年在上级医师监督下作为第一术者执行CEA手术。回顾性收集了2005年至2015年所有的CEA手术，并根据第一术者的专业水平比较了30天的结果：经验丰富的血管外科医生（EVS）与学员。所有CEA手术均在全身麻醉下进行，常规分流和修补。
在研究期间，共进行了1379例CEA手术（361例[26.2%]有症状；1018例[73.8%]无症状）。学员作为第一术者进行了199例（14.4%）CEA手术。除患者年龄（学员72.4岁 vs. EVS 70.8岁，P = 0.02）和吸烟史（学员30.7% vs. EVS 24.1%，P = 0.04）外，学员进行CEA手术的患者术前临床特征相似。学员进行CEA手术与EVS进行CEA手术的30天并发症发生率相似：卒中0.5% vs. 1.1%，P = 0.5；死亡0.0% vs. 0.5%，P = 0.6；卒中/死亡0.5% vs. 1.7%，P = 0.24；血肿3.0% vs. 2.2%，P = 0.48；以及颅神经损伤9.0% vs. 7.8%，P = 0.47。学员进行CEA手术的干预时间明显长于EVS：104 ± 1.9分钟 vs. 98 ± 1.0分钟，P = 0.02。
通过明确的CEA教学项目，学员可以在临床结果方面获得与经验更丰富的外科医生相似的结果，但代价是干预时间增加。
