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. 1998 Jul;85(7):939-42.
doi: 10.1046/j.1365-2168.1998.00740.x.

Provision of training in carotid surgery does not compromise patient safety

A R Naylor  1 , M M Thompson, K Varty, R D Sayers, N J London, P R Bell
Affiliations

Provision of training in carotid surgery does not compromise patient safety

A R Naylor et al. Br J Surg. 1998 Jul.

Abstract

Background: Vascular surgeons perceive that carotid endarterectomy carries a higher risk of stroke if performed by a surgical trainee. Accordingly, some trainees consider that they receive a less than adequate training in carotid surgery before taking up a consultant position. The aim of this study was to establish whether the stroke rate was adversely affected if carotid endarterectomy was performed by a surgical trainee under consultant supervision.

Methods: This was a prospective study of 151 consecutive patients undergoing carotid endarterectomy between 1 January and 31 December 1996 using a standardized technique including intraoperative and postoperative transcranial Doppler monitoring and completion angioscopy.

Results: The overall mortality and/or disabling stroke rate was 0.7 per cent (one of 151 patients), whereas the mortality and/or any stroke rate was 1.3 per cent (two of 151). Surgical trainees performed 82 of 151 carotid endarterectomies, with a mortality rate of 1 per cent and a mortality and/or any stroke rate of 2 per cent. There was no significant difference in the incidence of retained thrombus or intimal flaps between trainees and consultants as detected by angioscopy.

Conclusion: Vascular surgical trainees can receive a comprehensive training in carotid artery surgery without incurring an unacceptable increase in operative risk.

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