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- Title
Do trainees jeopardize the outcome of infra-inguinal bypass?
- Authors
Fisher, R.K; Brennan, J.A; Gilling-Smith, G.L; Bakran, A; Harris, P.L
- Abstract
Aim: A surgeon's accountability for his outcome figures may detract from realizing training opportunities during major procedures, and whilst patient welfare must take priority, the surgeons of tomorrow require adequate training. This study aimed to validate the participation of trainees in infra-inguinal arterial reconstruction in our institution. Methods: Interrogation of our audit database covering infra-inguinal bypass surgery during a 5-year period provided details of operations performed by consultants and trainees. Outcome measures were cumulative patency, limb salvage using Kaplan-Meier curves, and 30-day mortality. Results: Trainees performed 127 (27 percent) infra-inguinal bypass operations: 51 (40 per cent) above knee; 46 (36 per cent) below knee; 30 (24 per cent) distal. Consultants performed 341 (73 per cent) operations; 133 (39 per cent) above knee, 84 (25 per cent) below knee and 124 (36 per cent) distal. Similar patient demographics were noted between the two groups, and the outcome measures of each group are summarized in the table. Cumulative patency and limb-salvage rates for operations performed by trainees were compared to those by consultants and no statistical differences were found (P = 0.2601 and 0.9026, respectively; log-rank test). Thirty-day mortality was significantly higher after operation by a consultant, 5.5 per cent, compared to a trainee, 1.6 per cent (P < 0.0001, Chi-square test). Conclusion: The outcome after infra-inguinal bypass is not jeopardized by a trainee performing the operation, assuming appropriate supervision. The higher mortality in the consultant-operated group probably reflects appropriate case selection, with training allocated to fitter patients.
- Subjects
ARTERIAL surgery; TRAINING of surgeons
- Publication
British Journal of Surgery, 2002, Vol 89, p29
- ISSN
0007-1323
- Publication type
Article
- DOI
10.1046/j.1365-2168.89.s.1.13_2.x