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

Global shifts toward endovascular management of aortic aneurysms have altered learning opportunities for vascular surgery trainees.

A cross-sectional quantitative analysis of operative logbooks was conducted for all trainees in the Australia and New Zealand (ANZ) Vascular Surgery training program from 2015 to 2023. All aortic procedures were included; incomplete logbooks or partial training years were excluded. Descriptive statistics summarized procedural volume and trainee role (primary or chief surgeon versus assistant).

Logbooks from 99 trainees (77 men, 22 women) documented 10,335 aortic procedures (7,098 endovascular; 3,237 open). Median annual aortic case volume per trainee was 31 (range 5-82): 9 open (range 0-34) and 21 endovascular (range 2-66) procedures. Exposure to complex aortic surgery was low, with median 2 fenestrated/branched endovascular (range 0-15), and 3 thoracic endovascular repairs (range 0-22). Ruptured aortic exposure was similarly limited, with 1 open and 1 endovascular annually. Of 22 trainees with logbooks spanning the complete 5-year training program, median cumulative aortic volume was 126 per trainee (39 open, 87 endovascular). There were significant regional differences in open surgery (3-fold), and endovascular and open ruptured aneurysm repair. Male trainees were more likely to be recorded as primary surgeon for open (median 5 vs. 3, P = 0.05) and endovascular (median 14 vs. 10, P = 0.003).

Within a centralized training model including rotations across multiple geographical regions, vascular surgery trainees gain substantial experience in open and endovascular elective aortic surgery; however, exposure to complex and ruptured aortic repairs are limited and unevenly distributed. Gender disparities in operative autonomy were also identified.