Carotid endarterectomy results in the early years of practice

BACKGROUND Newly qualified surgeons, as well as their referring physicians, are understandably anxious when dangerous surgery is contemplated. Carotid endarterectomy (CEA), which requires a low morbidity/mortality rate to be successful, is especially problematic in this realm. There is a paucity of literature indicating the results that can be expected when a less-experien ced surgeon is asked to perform this procedure. As the volume of CEA surger y is expected to decrease in the future with improvements in endovascular t echniques, there will be fewer highly experienced CEA surgeons around. METHODS We studied the first consecutive, prospectively recorded 100 CEAs p erformed by each of two newly qualified surgeons (200 total) between Januar y 1993 and May 1998. Standard technique was used and all cases were done un der general anesthesia. The only difference in technique was the more liber al use of shunting and protamine by one individual. RESULTS There were no significant differences in the patient demographics b etween the two surgeons. Seventy-five percent of the cases harbored symptom atic stenoses. An overall combined stroke/mortality rate of 5.5% was observ ed. The rate in those operated on for symptomatic stenosis (n = 150) was 6% while it was 4% for those with asymptomatic pathology. There were no signi ficant differences in outcome between the two surgeons. The average stroke/ mortality rate in the first 50 cases for each surgeon was 7%, as opposed to 4% for the second 50 cases. CONCLUSIONS These data indicate that less-experienced individuals can perfo rm this procedure with good results. (C) 2001 by Elsevier Science Inc.