Assessing Aortic Case Volume and Operative Autonomy in a Centralized Binational Vascular Surgery Training Program.

Area of Science:

• Vascular Surgery
• Surgical Education
• Aortic Aneurysm Management

Background:

• The increasing prevalence of endovascular aortic aneurysm repair has impacted traditional surgical training paradigms.
• Opportunities for vascular surgery trainees to gain comprehensive experience may be affected by these shifts.

Purpose of the Study:

• To analyze the procedural volume and case distribution for vascular surgery trainees in Australia and New Zealand.
• To identify trends in exposure to open, endovascular, complex, and ruptured aortic repairs.
• To investigate potential gender disparities in operative autonomy.

Main Methods:

• A quantitative analysis of operative logbooks from trainees in the Australia and New Zealand Vascular Surgery program (2015-2023).
• Inclusion of all aortic procedures, with exclusion of incomplete data.
• Descriptive statistics used to summarize procedural volumes and trainee roles.

Main Results:

• 99 trainees logged 10,335 aortic procedures (7,098 endovascular, 3,237 open).
• Median annual trainee volume was 31 cases (21 endovascular, 9 open), with limited exposure to complex (2 fenestrated/branched, 3 thoracic endovascular) and ruptured aortic repairs.
• Male trainees showed greater likelihood of primary surgeon roles in both open and endovascular procedures.

Conclusions:

• Vascular surgery trainees achieve substantial experience in elective open and endovascular aortic surgery within a centralized training model.
• Exposure to complex and ruptured aortic repairs remains limited and unevenly distributed across trainees.
• Identified gender disparities in operative autonomy require further investigation and potential intervention.