Vascular Surgery Procedures Performed By Residents. A Narrative Review On The Impact In 30-Day Outcomes

Authors

  • Tiago Ribeiro Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central; Lisboa, Portugal https://orcid.org/0000-0001-9207-5226
  • Rita Soares Ferreira Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central; Lisboa, Portugal; NOVA Medical School|Faculdade de Ciências Médicas, NMS|FCM, Universidade Nova de Lisboa; Lisboa, Portugal
  • Rita Bento Centro Hospitalar Universitário Lisboa Central
  • Fábio Pais Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central; Lisboa, Portugal
  • Joana Cardoso Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central; Lisboa, Portugal https://orcid.org/0000-0002-8908-2318
  • Helena Fidalgo Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central; Lisboa, Portugal https://orcid.org/0000-0002-3757-8434
  • Adriana Figueiredo Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central; Lisboa, Portugal
  • Maria Emília Ferreira Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central; Lisboa, Portugal; NOVA Medical School|Faculdade de Ciências Médicas, NMS|FCM, Universidade Nova de Lisboa; Lisboa, Portugal https://orcid.org/0000-0002-2580-7519

DOI:

https://doi.org/10.48729/pjctvs.410

Keywords:

Vascular Surgery (MeSH), Training Programs (MeSH), Survival Analysis (MeSH), Complications (MeSH)

Abstract

Introduction: Worldwide, there is an increase in scrutiny after surgical treatment of a vast array of pathologies. Doing so, a large body of evidence clearly supports centralisation, such as teaching hospitals, where a larger caseload enables optimal outcomes. These institutions have a strong presence of surgical residents seeking training in both technical and non-technical skills. Inevitably, as part of training, they will be involved in the surgical treatment of those patients, even as the primary operator. We sought to investigate the impact of trainee performed procedures in outcomes of common vascular procedures of different technical complexity.
Methods: A non-systematic MEDLINE and Scopus databases review on the outcomes of resident performed common vascular procedures was performed.
Results: Specific evidence in many procedures (venous disease, aortic aneurysms, peripheral artery disease) is lacking. After carotid endarterectomy (CEA), resident performed procedures seem to have similar cranial nerve palsy and stroke when compared to expert surgeons. Generally, resident-performed primary radiocephalic and elbow arteriovenous fistula (AVF) presents similar primary and secondary patency. As with CEA, AVF procedures performed by residents took longer. On aortic aneurysms, although no specific comparison has been performed, resident involvement (irrespective of surgeon or assistant) in these procedures does not seem associated with increased adverse events.
Conclusion: In most vascular surgery procedures, little is known about resident performance and their impact on outcomes. Notwithstanding, resident-performed CEA and primary AVF seem free of major compromise to patients. Further research is warranted to clarify this topic.

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References

Meuli L, Menges AL, Stoklasa K, Steigmiller K, Reutersberg B, Zimmermann A. Inter-Hospital Transfer of Patients With Ruptured Abdominal Aortic Aneurysms in Switzerland. Eur J Vasc Endovasc Surg 2023; 65: 484-492.

Partridge E, Brooks M, Curd C, Davis V, Oates C, Mc Geeney D. The effects of centralisation of vascular surgical services in the Bath, Bristol and Weston area on the carotid endarterectomy pathway. Ann R Coll Surg Engl. 2017; 99: 617-623.

Holt PJ, Karthikesalingam A, Hofman D, Poloniecki JD, Hinchliffe RJ, Loftus IM et al. Provider volume and long-term outcome after elective abdominal aortic aneurysm repair. Br J Surg 2012; 99: 666-672.

Budtz-Lilly J, Björck M, Venermo M, Debus S, Behrendt CA, Altreuther M et al. The impact of centralisation and endovascular aneurysm repair on treatment of ruptured abdominal aortic aneurysms based on international registries. Eur J Vasc Endovasc Surg 2018; 56: 181-188.

Trenner M, Kuehnl A, Salvermoser M, Reutersberg B, Geisbuesch S, Schmid V et al. Editor's Choice – High annual hospital volume is associated with decreased in hospital mortality and complication rates following treatment of abdominal aortic aneurysms: secondary data analysis of the Nationwide German DRG Statistics from 2005 to 2013. Eur J Vasc Endovasc Surg. 2018; 55: 185-194

Ribeiro TF, Soares Ferreira R, Correia R, Bastos Gonçalves F, Amaral CO, Ferreira ME. Safety of Ruptured Abdominal Aortic Aneurysm Repair Performed by Supervised Trainees as Primary Operators: Analysis of a Contemporary Propensity Matched Cohort. Eur J Vasc Endovasc Surg. 2024. E-pub ahead of print.

DiDato S, Farber A, Rybin D, Kalish JA, Eslami MH, Moreira CC et al. The effect of trainee involvement on perioperative outcomes of abdominal aortic aneurysm repair. J Vasc Surg. 2016; 63: 16-22.

Meguid RA, Brooke BS, Perler BA, Freischlag JA. Impact of hospital teaching status on survival from ruptured abdominal aortic aneurysm repair. J Vasc Surg. 2009; 50: 243-250.

Brahmbhatt R, Gander J, Duwaryi Y, Ravi RR, Veeraswamy R, Salam A et al. Improved Trends in Patient Survival and Decreased Major Complications After Ruptured Abdominal Aortic Aneurysm Repair. J Vasc Surg 2016. 63: 39-47

Acheampong DO, Paul P, Guerrier S, Boateng P, Leitman IM. Effect of Resident Involvement on Morbidity and Mortality Following Thoracic Endovascular Aortic Repair. J Surg Educ. 2018; 75: 1575-1582.

Lazarides MK, Georgiadis GS, Georgakarakos EI. What is the best training for vascular access surgery? J Vasc Access. 2015; 16:S16-9.

Regus S, Almási-Sperling V, Rother U, Meyer A, Lang W. Surgeon experience affects outcome of forearm arteriovenous fistulae more than outcomes of upper-arm fistulae. J Vasc Access. 2017; 18:120-125.

Manohar M, Pol MM, Winston B, Chauhan A, Jarapala V, Sahir M. Effect of supervised surgical training provided to general surgery residents on clinical maturation of arteriovenous fistula surgery: A retrospective cohort study. Ann Med Surg (Lond). 2022; 82:104780.

McGrogan DG, Maxwell AP, Inston NG, Krishnan H, Field M. Preserving arteriovenous fistula outcomes during surgical training. J Vasc Access. 2014; 15: 474-80.

Gundevia Z, Whalley H, Ferring M, Claridge M, Smith S, Wilmink T. Effect of operating surgeon on outcome of arteriovenous fistula formation. Eur J Vasc Endovasc Surg. 2008; 35:614-618.

Fassiadis N, Morsy M, Siva M, Marsh JE, Makanjuola AD, Chemla ES. Does the surgeon’s experience impact on radiocephalic fistula patency rates? Semin Dial 2007; 20: 455-457.

Bath MF, Awopetu AI, Stather PW, Sadat U, Varty K, Hayes PD. The impact of surgeon experience, Supervised Trainee vs Trained Surgeon, in Vascular Surgery Procedures: A systematic Review and Meta-Analysis. Eur J Vasc Endovasc Surg 2019. 58: 292-298

Iannuzzi JC, Chandra A, Rickles AS, Kumar NG, Kelly KN, Gillespie DL et al. Resident involvement is associated with worse outcomes after major lower extremity amputation. J Vasc Surg 2013; 58: 827-831

Cosgrove CM, Thornberry DJ, Wilkins DC, Ashley S. Surgical experience and supervision may influence the quality of lower limb amputation. Ann R Coll Surg Engl 2002; 84: 344-347

Bradbury A, Brittenden J, Murie J, Jenkins A, Ruckley C. Supervised training in carotid endarterectomy is safe. Br J Surg 1997; 84:1708-1710;

Cacioppa LM, Pini R, Longhi M, Vacirca A, Gallitto E, Faggioli G,et al. The value of carotid endarterectomy as a learning tool for trainees. Ann Vasc Surg 2018; 47:195-199.

Pai M, Handa A, Hands L, Collin J. Adequate vascular training; opportunities can be provided without compromising patient care. Eur J Vasc Endovasc Surg 2002; 23: 524-527.

Lutz HJ, Michael R, Gahl B, Savolainen H. Is carotid endarterectomy a trainee operation? World J Surg 2009; 33: 242-245.

Metzger P, Aspalter M, Guggenbichler S, Dabernig W, Linni K, Butturini E, et al. Case numbers in carotid surgery training can be accomplished and are not associated with an inferior outcome. Results of a university based tertiary care center study. Eur Surg 2014; 46: 239-243.

Naylor AR, Thompson MM, Varty K, Sayers RD, London NJM, Bell PRF. Provision of training in carotid surgery does not compromise patient safety. Br J Surg 1998; 85:939-942.

Ricco JB, Régnault De La Mothe G, Fujita S, Page O, Valagier A, Marchand C. Impact of routine completion angiography on the results of primary carotid endarterectomy: a prospective study in a teaching hospital. Eur J Vasc Endovasc Surg 2011; 41:579-588.

Rijbroek A, Wisselink W, Rauwerda JA. The impact of training in patients on mortality and morbidity in carotid endarterectomy in a vascular training center and the recommendations of the European Board of Surgery Qualification in Vascular Surgery. Eur J Vasc Endovasc Surg 2003; 26: 256-261

Krupski WC, Effeney DJ, Goldstone J, Deuel M, Webb RL, Etheredge SN et al. Carotid endarterectomy in a metropolitan community: comparison of results from three institutions. Surgery 1985; 98:492-499.

Naylor R, Rantner B, Ancetti S, de Borst GJ, De Carlo M, Halliday A et al. Editor's Choice - European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on the Management of Atherosclerotic Carotid and Vertebral Artery Disease. Eur J Vasc Endovasc Surg. 2023; 65 (1):7-111.

UEMS Training Requirements in Vascular Surgery https:// www.uems.eu/__data/assets/pdf_file/0005/148406/ UEMS-2021.19-European-Training-Requirements-in-Vascular-Surgery.pdf Date accessed: 08/03/2024

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Published

07-07-2024

How to Cite

1.
Ribeiro T, Soares Ferreira R, Bento R, Pais F, Cardoso J, Fidalgo H, Figueiredo A, Ferreira ME. Vascular Surgery Procedures Performed By Residents. A Narrative Review On The Impact In 30-Day Outcomes. Rev Port Cir Cardiotorac Vasc [Internet]. 2024 Jul. 7 [cited 2024 Jul. 18];31(2):41-5. Available from: https://pjctvs.com/index.php/journal/article/view/410

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