Nunes Celso, Antunes Luís, Lopes Catarina, O'neill Pedrosa João, Silva Eduardo, Fonseca Manuel
Trainee in Vascular Surgery Department, Centro Hospitalar e Universitário de Coimbra, Coimbra City, Portugal.
Vascular Surgeon, Centro Hospitalar e Universitário de Coimbra, Coimbra City, Portugal; Faculty of Medicine in University of Coimbra, Coimbra City, Portugal.
Ann Vasc Surg. 2025 Jan;110(Pt B):342-346. doi: 10.1016/j.avsg.2024.07.098. Epub 2024 Aug 3.
This study assesses the impact of having a surgical trainee performing a carotid endarterectomy (CEA) procedure on the postoperative rates of stroke and death.
In this observational retrospective study, consecutive patients, who underwent CEA between May 01, 2016, and July 31, 2022, were entered into a retrospectively collected database. Patients were stratified into 2 categories - consultant-led cases and trainees-led cases. Primary outcomes were 30-day stroke rate, and 30-day morbimortality. A sub analysis was performed after grouping the patients in whether there was a neurological event in the previous 6 months - symptomatic or asymptomatic.
RESULTS/CONCLUSIONS: Trainees-led cases had significantly longer clamping times and higher rates of stroke in asymptomatic patients compared with consultant-led cases. Patient's safety should be our top priority. Any practice leading to a significantly increased rate of postoperative stroke must be discontinued. Training protocols and adequate supervision must ensure that trainees possess the necessary skills and knowledge to safely and effectively perform CEA procedures, thereby prioritizing patient safety.
本研究评估由外科住院医师进行颈动脉内膜切除术（CEA）对术后中风和死亡率的影响。
在这项观察性回顾性研究中，将2016年5月1日至2022年7月31日期间连续接受CEA手术的患者纳入一个回顾性收集的数据库。患者被分为两类——由顾问医生主导的病例和由住院医师主导的病例。主要结局指标为30天中风率和30天病残死亡率。在根据患者在过去6个月内是否发生过神经系统事件（有症状或无症状）进行分组后进行了亚组分析。
结果/结论：与顾问医生主导的病例相比，住院医师主导的病例中无症状患者的夹闭时间明显更长，中风发生率更高。患者安全应是我们的首要任务。任何导致术后中风发生率显著增加的做法都必须停止。培训方案和充分的监督必须确保住院医师具备安全有效地进行CEA手术所需的技能和知识，从而将患者安全放在首位。
