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Trainee Effect on Procedural Efficiency is Limited in Vascular Surgery Operations.
Kyle Steiger1, Michael A Edwards2, Aaron Spaulding3
1Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, FL.
Annals of Vascular Surgery
|November 28, 2022
Summary
Surgical residents generally do not increase vascular surgery operative times, though some procedures like AVF creation may take longer with trainees. Further research is needed on resident experience and case complexity.
Area of Science:
- Vascular Surgery
- Surgical Education
- Healthcare Operations
Background:
- Optimizing surgical training requires balancing resident education with patient safety and efficient operating times.
- The impact of surgical team composition on elective vascular surgery durations is not well understood.
- Understanding factors influencing operative time is crucial for improving patient outcomes and surgeon well-being.
Purpose of the Study:
- To investigate how the composition of the vascular surgical team affects elective operative times.
- To determine if the presence of anesthesia and surgical trainees influences operative durations.
- To analyze the effect of the number of circulating nurses and time of day on operative times.
Main Methods:
- Retrospective review of 853 elective vascular surgery operations between January 2019 and October 2021.
- Reference procedure: arteriovenous fistula (AVF) creation. Key variables: team composition (anesthesia, surgery trainees, nurses) and time of day.
- Operative time (wheels-in to wheels-out) analyzed in three subintervals; linear regression used to assess team composition and time of day effects.
Main Results:
- Most procedures showed varied operative times compared to AVF creation; some were shorter (amputations, arteriograms), others significantly longer (endarterectomy, bypass, aortic repairs).
- Anesthesia trainees were associated with a significant reduction in the close to wheels-out interval (-2.4 min).
- Surgical residents increased AVF creation time (wheels-in to cut: +4.2 min; cut to close: +13 min), and arteriogram time was longer with a surgeon alone (+5.6 min).
Conclusions:
- General surgery residents typically do not extend vascular surgery case durations.
- Increased operative time with residents may occur in specific procedures like AVF creation, potentially due to greater autonomy.
- Future research should explore multi-center studies examining resident experience levels and case complexity to understand their impact on procedural length and outcomes.
