SUPERVISED TRAINING IN CAROTID ENDARTERECTOMY IS SAFE

Background The number of carotid endarterectomies (CEAs) performed in the UK, and thus the need to train surgeons in this operation, has inc reased 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 performe d in this unit since 1975. Results Between 1 January 1975 and 31 Decem ber 1991, 247 CEAs were performed of which only 12 were done by superv ised trainees. By contrast, between 1 January 1992 and 1 July 1996, 21 9 CEAs were performed, 92 (42 per cent) hy supervised trainees (P < 0. 0001). In cases performed since 1 January 1992, there was no significa nt difference between trainee and consultant operations with regard to age and sex of patient, smoking history, ischaemic heart disease, hyp ertension, diabetes, presence of preoperative infarction on computed t omography, indications fur operation, degree of ipsilateral carotid st enosis, status of the contralateral carotid artery, use of a shunt or patch angioplasty. Since I January 1992, tile total perioperative neur ological event rate fur supervised trainees was seven of 92 (7.6 per c ent) of which one was fatal (cerebral infarction). The total neurologi cal 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 fat al (one cerebral infarction and one haemorrhage), Conclusion Since 199 1 there has been a tenfold increase in the proportion of CEAs being pe rformed by supervised trainees. This has been accomplished without det erioration in clinical outcome. With adequate supervision, training in CEA call be safe, even when trainees are exposed to a true cross-sect ion of low-, medium- and high-risk cases.