This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Training in infrainguinal bypass surgery for severe leg ischaemia. BJS 2001; 88: 82-84.
Published: 6th December 2002
Authors: L. Papp, S. M. Evans, J. Kelman, R. T. A. Chalmers, J. A. Murie, A. W. Bradbury et al.
Background
Recent changes in surgical training in the UK mean that operative experience must be gained more efficiently. However, it is important to demonstrate that improved training opportunities are not associated with inferior patient outcomes. The aim was to examine changes in training in infrainguinal bypass surgery and to compare the outcomes of operations performed by consultants and trainees.
Method
A prospectively gathered, computerized database of 1077 consecutive infrainguinal bypasses performed on 1003 patients for chronic severe leg ischaemia between 1 January 1983 and 31 December 1998 was analysed.
Results
Consultants performed 733 (68 per cent) infrainguinal bypasses to the following distal sites: 347 (47 per cent) above‐knee popliteal artery, 257 (35 per cent) below‐knee popliteal artery, 121 (17 per cent) to a crural artery and eight (1 per cent) other. Trainees performed 344 operations: 170 (49 per cent) were to the above‐knee popliteal artery, 122 (35 per cent) to the below‐knee popliteal artery, 48 (14 per cent) crural and four (1 per cent) other. The operative mortality rate was 27 (4 per cent) of 733 for consultants and 11 (3 per cent) of 344 for trainees (P > 0·05, χ2 test). There were no significant differences in patency or limb salvage at 36 months after operation between consultants and trainees, regardless of the site of distal anastomosis and the type of conduit used.
Conclusion
With appropriate case selection and supervision, training in infrainguinal bypass grafting does not compromise early or long‐term patient outcomes.
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