Training in abdominal aortic aneurysm (AAA) repair: 1987-1997

Area of Science:

• Vascular Surgery
• Surgical Training
• Healthcare Policy

Background:

• Reduced working hours in the UK have led to shorter surgical training durations.
• Surgical trainees must acquire operative experience more rapidly.
• Abdominal aortic aneurysm (AAA) repair is a key vascular indicator operation.

Purpose of the Study:

• To evaluate the impact of shortened surgical training on outcomes of abdominal aortic aneurysm (AAA) repair.
• To assess if trainees can gain necessary experience efficiently within reduced training periods.
• To analyze changes in AAA repair procedures and their association with trainee involvement and patient outcomes.

Main Methods:

• Analysis of a prospectively collected database of 1136 AAA repairs (elective and emergency).
• Comparison of two distinct time periods: 1987-1991 and 1992-1997.
• Statistical analysis to assess changes in consultant involvement, trainee supervision, and operative mortality.

Main Results:

• A significant decrease in consultant-performed AAA repairs across asymptomatic, elective symptomatic, emergency symptomatic, and ruptured cases since 1991.
• An associated increase in the proportion of AAA repairs performed with trainee assistance or solo by trainees.
• No significant change in operative mortality between the two periods, irrespective of consultant presence.

Conclusions:

• Supervised surgical trainees can safely undertake an increasing volume of AAA surgery.
• Trainees can operate independently ('solo') in selected AAA repair cases without adverse impact on mortality.
• Continuous auditing of surgical training against clinical outcomes is essential for meeting patient and trainee needs.