Patient outcomes following carotid endarterectomy are not adversely affected by surgical trainees’ operative involvement: A retrospective cohort study

Abstract Background Surgical training is an increasingly controversial topic. Concerns have been raised about both training opportunities becoming scarcer and poorer outcomes in operations led by surgical trainees; despite the evidence base for this being mixed. This retrospective cohort study aims to compare outcomes following carotid endarterectomy in patients who were operated on by a surgical trainee to those operated on by consultants. Materials and methods Consecutive patients, who underwent carotid endarterectomy between 01/06/2012 and 1/12/2016, were entered into a prospectively maintained database. Patients were grouped according to whether a consultant or trainee vascular surgeon was the lead operating surgeon. Outcomes were 30-day mortality, 30-day stroke rate, operation time and complication rate. Results One-hundred-and-twenty-one patients, with a mean age of 70.3 years, underwent carotid endarterectomy over a 4.5-year period. They were classified by the grade of the lead operating surgeon: consultant (n = 74) or registrar (n = 47). The median operative time was 117 min for consultants and 115 min for registrars with no significant difference between the two groups (p = 0.78). Three patients died in the post-op period, 2 secondary to post-operative stroke and a further 5 had nonfatal strokes. Grade of surgeon was also found to have no impact on 30- day mortality (p = 0.99) or stroke rate (p = 0.99). Sixty-six patients experienced post-operative complications, of varying severity, but no significant difference (p = 0.66) was found in incidence between trainee (57%) and consultant (53%) groups. Conclusion Trainee involvement in carotid endarterectomy, with consultant supervision, leads to equivalent outcomes and represents a safe and useful training opportunity.