PROVISION OF TRAINING IN CAROTID SURGERY DOES NOT COMPROMISE PATIENT SAFETY

Background Vascular surgeons perceive that carotid endarterectomy carr ies a higher risk of stroke if performed by a surgical trainee. Accord ingly, some trainees consider that they receive a less than adequate t raining in carotid surgery before taking up a consultant position. The aim of this study was to establish whether the stroke rate was advers ely affected if carotid endarterectomy was performed by a surgical tra inee under consultant supervision. Methods This was a prospective stud y of 151 consecutive patients undergoing carotid endarterectomy betwee n 1 January and 31 December 1996 using a standardized technique includ ing intraoperative and postoperative transcranial Doppler monitoring a nd completion angioscopy. Results The overall mortality and/or disabli ng stroke rate was 0.7 per cent (one of 151 patients), whereas the mor tality and/or any stroke rate was 1.3 per cent (two of 151). Surgical trainees performed 82 of 151 carotid endarterectomies, with a mortalit y rate of 1 per cent and a mortality and/or any stroke rate of 2 per c ent. 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 co mprehensive training in carotid artery surgery without incurring an un acceptable increase in operative risk.