Upper-Extremity Vascular Exposures for Trauma: Comparative Performance Outcomes for General Surgeons and Orthopedic...

Area of Science:

• Surgical Education
• Trauma Surgery
• Vascular Surgery

Background:

• Military surgeons increasingly manage trauma from non-combat events in austere settings.
• Upper-extremity vascular injuries pose high morbidity/mortality risks if hemorrhage is not controlled.
• General and orthopedic surgeons in deployed teams often lack expertise in managing these specific vascular injuries.

Purpose of the Study:

• To assess baseline surgical exposure and control capabilities for axillary and brachial arteries in general and orthopedic surgeons.
• To evaluate the effectiveness of a cadaver-based training intervention in improving these surgical skills.

Main Methods:

• Cadaveric assessment of procedural capabilities for exposing and controlling axillary and brachial vessels.
• 1:1 procedural training followed by post-training re-assessment.
• Inferential analyses (ANOVA/MANOVA) and effect size calculations (Cohen's d).

Main Results:

• Significant baseline performance differences existed, with general surgeons initially outperforming orthopedic surgeons.
• Neither group met performance benchmarks pre-training.
• Post-training, both groups showed significant improvements in overall and critical procedural abilities, with medium to very large effect sizes.

Conclusions:

• A notable capability gap exists for both surgeon groups in managing upper-extremity vascular injuries.
• The cadaver-based training effectively improved surgical proficiency for managing these injuries.
• Training is essential for surgeons in remote, expeditionary, or global health contexts to improve extremity trauma care quality.