# Intraoperative teaching styles: preferences of surgical residents {#article-title-2} There is variation in the way different surgeons teach in the operating room setting. Surgical residents in training may have preferences and opinions on how these teaching styles affect their learning. While
ObjectiveLeft vertebral artery revascularization is indicated in surgery involving Zone 2 of the aortic arch and is typically accomplished indirectly via subclavian artery revascularization. For aberrant left vertebral anatomy, direct revascularization is indicated. Our objective was to compare the outcomes of direct vertebral artery revascularization with indirect subclavian artery revascularization for treating aortic arch pathology and to identify predictors of mortality.MethodsA retrospective cohort study was conducted at a single tertiary hospital, including patients who underwent open or endovascular vertebral artery revascularization from 2005 to 2022. Those that underwent direct vertebral revascularization were compared to those that were indirectly revascularized via subclavian artery revascularization. The outcomes of interest were a composite outcome (any of death, stroke, nerve injury, thrombosis) and mortality. Univariate logistic regression models were fitted to quantify the strength of differences between the direct and indirect revascularization cohorts. Cox-regression was used to identify mortality predictors.ResultsOut of 143 patients who underwent vertebral artery revascularization, 21 (14.7%) patients had a vertebral artery originating from the aortic arch. The median length of stay was 10 days (IQR, 6-20 days), and demographics were similar between cohorts [Table I]. The incidence of composite outcome, bypass thrombosis and hoarseness were significantly higher in the direct group (42.9% vs. 18.0%, p=0.019; 33.3% vs. 0.8%, p<0.0001; 57.1% vs. 18.0%, p<0.001, respectively). The direct group was ∼3x more likely to experience the composite outcome (odds ratio [OR], 3.41; 95% CI,1.28,9.08); similarly, this group was ∼6x more likely to have hoarseness (OR, 5.88; 95% CI, 2.21, 15.62) [Table II]. There was no significant difference in mortality rates at 30 days, 1-, 3-, 5- and 10-years of follow-up. Age, length of hospital stay, and congestive heart failure were identified as predictors of higher mortality. After adjusting for these covariates, the group itself was not an independent predictor of mortality [Table III].ConclusionsDirect vertebral revascularization was associated with higher rates of bypass thrombosis, composite outcome (death, stroke, nerve injury, thrombosis) and hoarseness. Patients with aberrant vertebral anatomy are at higher risks of these complications compared to patients with standard arch anatomy. However, after adjusting for other factors, mortality rates were not significantly different between the groups.
Background This study’s objective is to evaluate the emotional experiences, coping mechanisms, and support resources for Canadian vascular surgeons and trainees following an adverse patient event or near miss. Methods This is a cross-sectional survey study of all Canadian Society for Vascular Surgery (CSVS) members from October to November 2021. We collected data on participant experiences with adverse events, their emotional responses, the coping mechanisms used, and their perceptions on available support resources. Results The survey was sent to 233 CSVS members yielding 66 responses. The majority (77%) of respondents had experiences with adverse event causing serious patient harm. The most common negative experience following an adverse event included feelings of negativity towards oneself, general distress, and anxiety about potential for future errors. The most common coping mechanism was seeking advice from a mentor or close colleague. Peers (82%) and senior colleagues (59%) were the most preferred sources of support. Most of the respondents would reach out to a mentor if they had 1, but 30% reported no mentor or close colleague for support. Conclusion Adverse patient events and near misses have serious negative impact on the lives of Canadian vascular surgeons and trainees. Peers and senior colleagues are the most desired source for support, but this is not universally available. Organized efforts are needed to bring awareness in our vascular surgery community on the ubiquitous nature and detrimental effects of adverse events.
