Supervised training in carotid endarterectomy is safe

Abstract

Background: The number of carotid endarterectomies (CEAs) performed in the UK, and thus the need to train surgeons in this operation, has increased markedly in recent years and may continue to do so. The aim of the present study was to assess the quality, clinical outcome and case-mix of supervised training in CEA in this unit.

Methods: The study was an analysis of a prospectively gathered database of all CEAs performed in this unit since 1975.

Results: Between 1 January 1975 and 31 December 1991, 247 CEAs were performed of which only 12 were done by supervised trainees. By contrast, between 1 January 1992 and 1 July 1996, 219 CEAs were performed, 92 (42 per cent) by supervised trainees (P < 0.0001). In cases performed since 1 January 1992, there was no significant difference between trainee and consultant operations with regard to age and sex of patient, smoking history, ischaemic heart disease, hypertension, diabetes, presence of preoperative infarction on computed tomography, indications for operation, degree of ipsilateral carotid stenosis, status of the contralateral carotid artery, use of a shunt or patch angioplasty. Since 1 January 1992, the total perioperative neurological event rate for supervised trainees was seven of 92 (7.6 per cent) of which one was fatal (cerebral infarction). The total neurological event rate for operations done by a consultant was nine of 127 (7.1 per cent), of which one was permanent and disabling and two were fatal (one cerebral infarction and one haemorrhage).

Conclusion: Since 1991 there has been a tenfold increase in the proportion of CEAs being performed by supervised trainees. This has been accomplished without deterioration in clinical outcome. With adequate supervision, training in CEA can be safe, even when trainees are exposed to a true cross-section of low-, medium- and high-risk cases.