Brown Leo R, Anderson Jamie, Bhattacharya Vish
Department of Vascular Surgery, Queen Elizabeth Hospital, Gateshead, NE9 6SX, United Kingdom.
Ann Med Surg (Lond). 2019 Jan 21;39:1-4. doi: 10.1016/j.amsu.2019.01.001. eCollection 2019 Mar.
Surgical training is an increasingly controversial topic. Concerns have been raised about both training opportunities becoming scarcer and poorer outcomes in operations led by surgical trainees; despite the evidence base for this being mixed. This retrospective cohort study aims to compare outcomes following carotid endarterectomy in patients who were operated on by a surgical trainee to those operated on by consultants.
Consecutive patients, who underwent carotid endarterectomy between 01/06/2012 and 1/12/2016, were entered into a prospectively maintained database. Patients were grouped according to whether a consultant or trainee vascular surgeon was the lead operating surgeon. Outcomes were 30-day mortality, 30-day stroke rate, operation time and complication rate.
One-hundred-and-twenty-one patients, with a mean age of 70.3 years, underwent carotid endarterectomy over a 4.5-year period. They were classified by the grade of the lead operating surgeon: consultant (n = 74) or registrar (n = 47). The median operative time was 117 min for consultants and 115 min for registrars with no significant difference between the two groups (p = 0.78). Three patients died in the post-op period, 2 secondary to post-operative stroke and a further 5 had nonfatal strokes. Grade of surgeon was also found to have no impact on 30- day mortality (p = 0.99) or stroke rate (p = 0.99). Sixty-six patients experienced post-operative complications, of varying severity, but no significant difference (p = 0.66) was found in incidence between trainee (57%) and consultant (53%) groups.
Trainee involvement in carotid endarterectomy, with consultant supervision, leads to equivalent outcomes and represents a safe and useful training opportunity.
外科培训是一个争议日益增加的话题。人们对培训机会越来越稀缺以及由外科实习生主导的手术中较差的结果都表示担忧；尽管支持这一观点的证据并不一致。这项回顾性队列研究旨在比较由外科实习生进行手术的患者与由顾问医生进行手术的患者在颈动脉内膜切除术后的结果。
2012年6月1日至2016年12月1日期间接受颈动脉内膜切除术的连续患者被纳入一个前瞻性维护的数据库。患者根据主刀医生是顾问血管外科医生还是实习血管外科医生进行分组。结果指标为30天死亡率、30天卒中率、手术时间和并发症发生率。
在4.5年的时间里，121例平均年龄为70.3岁的患者接受了颈动脉内膜切除术。他们根据主刀医生的级别进行分类：顾问医生（n = 74）或住院医生（n = 47）。顾问医生的中位手术时间为117分钟，住院医生为115分钟，两组之间无显著差异（p = 0.78）。3例患者在术后死亡，2例死于术后卒中，另有5例发生非致命性卒中。还发现医生级别对30天死亡率（p = 0.99）或卒中率（p = 0.99）没有影响。66例患者出现了不同严重程度的术后并发症，但实习生组（57%）和顾问医生组（53%）之间的发生率没有显著差异（p = 0.66）。
在顾问医生的监督下，实习生参与颈动脉内膜切除术可带来相当的结果，并且是一个安全且有用的培训机会。
