Gundevia, Z and Whalley, H and Ferring, M and Claridge, M and Smith, S and Wilmink, T (2008) Effect of operating surgeon on outcome of arteriovenous fistula formation. European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery, 35 (5). pp. 614-8. ISSN 1532-2165. This article is accessible to all HEFT staff and students via NHS Evidence www.evidence.nhs.uk by using their HEFT Athens login IDsFull text not available from this repository.
To study whether surgical trainees can perform arteriovenous fistula (AVF) surgery to a standard comparable to consultants.
PATIENTS AND METHODS
Retrospective study of all vascular access surgery over a three year period at a single centre. The operating surgeon was identified from theatre log books and categorised by grade. Fistula patency was used as the primary outcome measure and was determined from patients' case-notes and from a prospectively collected electronic record of dialysis sessions. Patency was defined as "used for dialysis" if the AVF was used for dialysis for at least 6 consecutive sessions.
One hundred and eighty six cases were used for analysis. In 60 cases (32%) the operating surgeon was the consultant, in 53 cases (29%) a trainee was supervised by a consultant, in 56 cases (30%) a trainee performed the operation independently and in 17 cases (9%) the grade of the operating surgeon could not be established. Primary and primary assisted patency rates by operating surgeon did not differ significantly (P-values 0.25 and 0.16 respectively). Age of the patient was the only predictor of patency failure in a multivariate model. Grade of operating surgeon (logrank test chi(2)=3.1, p=0.38) and type of fistula (logrank test chi(2)=2.3, p=0.52) were not significantly related to the primary survival of the fistula.
This study showed no significant differences in AVF patency rates between trainee and consultant surgeons. Allocation of appropriate cases can result in trainees obtaining similar outcomes as consultants, demonstrating that dialysis access surgery can provide good training opportunities for junior doctors without detriment to patient care.
|Additional Information:||This article is accessible to all HEFT staff and students via NHS Evidence www.evidence.nhs.uk by using their HEFT Athens login IDs|
|Subjects:||WG Cardiovascular system. Cardiology
|Divisions:||Planned IP Care > General Surgery
Planned IP Care > Vascular
|Depositing User:||Sophie Rollason|
|Date Deposited:||10 Jun 2014 13:15|
|Last Modified:||10 Jun 2014 13:15|
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