Impact of Surgeon Experience During Carotid Endarterectomy Operation and Effects on
            Perioperative Outcomes

Yüksel, Volkan; Özdemir, Ahmet Coşkun; Hüseyın, Serhat; Güçlü, Orkut; Turan, Fatma Nesrin; Canbaz, Suat

doi:10.5935/1678-9741.20160088

Cited by 3 publications

(2 citation statements)

References 18 publications

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“…Studies of vertical incisions in CEA have shown that a minimal incision causes fewer local neurologic complications than a conventional incision, but no statistical differences have been observed in the incidence of stroke and death [ 2 , 6 , 10 ]. This is corroborated by the results of our study.…”

Section: Discussionmentioning

confidence: 99%

High Mini-Skin Incision during Carotid Endarterectomy for Carotid Stenosis

et al. 2022

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Background: Carotid endarterectomy (CEA) is used to treat carotid stenosis, which is associated with cerebral infarction and may result in neurologic deficits such as stroke, transient ischemic attack (TIA), and local nerve injury. To decrease surgery-related complications and improve patient satisfaction with esthetic outcomes, efforts have been made to minimize incision size instead of using a standard longitudinal incision. Methods: We performed a retrospective analysis of 151 cases of CEA, of which 110 used conventional incisions and 41 used high mini-skin incisions (HMIs), from March 2015 to December 2021 at a single institution. Short-term (30-day) postoperative results were evaluated for rates of mortality, stroke, TIA, and cranial/cervical nerve injuries. Risk factors for nerve injury were also assessed. Results:The HMI group showed significantly (p<0.01) shorter operative and clamp times than the conventional group. The HMI group also had significantly shorter incision lengths (5.3±0.9 cm) than the conventional group (11.5±2.8 cm). The rates of stroke, TIA, and death at 30 days were not significantly different between the 2 groups. There was no significant difference in the rate of cranial and cervical nerve injuries, and all injuries were transient. A high lesion level (odds ratio [OR], 9.56; 95% confidence interval [CI], 3.21−28.42; p<0.01) and the clamp time (OR, 1.07; 95% CI, 1.03−1.12; p<0.01) were found to be risk factors for nerve injuries. Conclusion: Use of the HMI in CEA for carotid stenosis was advantageous for its shorter operative time, shorter internal carotid artery clamp time, reduced neurologic complications, and improved esthetics.

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Section: Discussionmentioning

confidence: 99%

High Mini-Skin Incision during Carotid Endarterectomy for Carotid Stenosis

et al. 2022

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“…Shorter longitudinal incisions have been postulated to be associated with the reduced risk of cranial nerve injury (CNI), whereas transversely sited skin-crease incisions may offer improved cosmesis without increasing the risk of CNI [2,6,7]. The risk of suboptimal exposure of the carotid lesion with shorter or transverse incisions can be reduced by identifying the level of the bifurcation preoperatively, and various methods have been employed to achieve this including the use of color-enhanced Duplex ultrasound (CDUS), magnetic resonance imaging, and skin surface anatomy or landmarks [2,3,5,8,9].…”

Section: Introductionmentioning

confidence: 99%

Outcomes after Transverse-Incision ‘Mini’ Carotid Endarterectomy and Patch-Plasty

Sinha

Fok

Goh

et al. 2019

VSI

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PurposeTraditional exposure for carotid endarterectomy (CEA) involves making a longitudinal incision parallel to the anterior border of the sternocleidomastoid. Such incisions can be painful, aesthetically displeasing, and associated with a high incidence of cranial nerve injury (CNI). This study describes the outcomes of CEA performed through small (<5 cm long), transversely oriented incisions located directly over the carotid bifurcation, as identified by color-enhanced Duplex ultrasound.Materials and MethodsPatient demographics and operative data were collected retrospectively from an in-house database of consecutive vascular patients undergoing CEA with a small transversely oriented incision for both symptomatic and asymptomatic carotid artery stenoses.ResultsA total of 52 consecutive patients underwent CEA between 2012 and 2016 (median age, 73.5 years; interquartile range, 67–80.3; male/female ratio, 40:12). CEA was performed under regional/local anesthesia (LA) in 48 (92.3%) patients, with 4 (7.7%) being performed under general anesthesia. One patient under LA experienced neurological dysfunction intraoperatively (manifesting as an inability to count out loud) that resolved with insertion of shunt. One patient experienced a transient neurological event (expressive dysphasia) within the immediate postoperative period, which resolved within 6 hours. No in-hospital death or perioperative major adverse cardiovascular events were noted. No persistent CNIs nor bleeding complications necessitating re-exploration were reported. Follow-up data were available for a median period of 3.1 years and for all patients. Three patients experienced strokes following discharge (2 strokes contralateral to and 1 transient ischemic attack ipsilateral to the operated side).ConclusionSmall, transversely orientated incisions, hidden within a neck skin crease can be safely performed in the majority of patients undergoing CEA.

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A National Comparison of Operative Outcomes of New and Experienced Surgeons

et al. 2019

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While prior studies suggest that patients of new surgeons fare worse than those of experienced surgeons, it is unclear whether outcomes differ due to surgeon experience level or the context in which care is delivered. This study compares outcomes among fee-for-service Medicare beneficiaries receiving care from new and experienced surgeons at the same hospitals, taking into account operation type, emergency admission status, and patient risk factors, including comorbidities.The authors investigated differences in 30-day mortality, as well as other clinical and utilization outcomes, among beneficiaries who underwent orthopedic or general surgery between 2009 and 2013. Surgeons were considered "new" within the first three years of practice, and "experienced" if they had at least 10 years of practice experience. COLONIAL PENN CENTER | 3641 LOCUST WALK | PHILADELPHIA, PA 19104-6218 | LDI.UPENN.EDU | P: 215-898-5611 | F: 215-898-0229 | @PENNLDI KEYFINDINGSIn this national study, Medicare beneficiaries treated by new surgeons had poorer outcomes than those treated by experienced ones in the same hospitals. However, the type of operation and the patient' s emergency status -rather than physician inexperience -explains nearly all poorer outcomes. Higher-risk cases are disproportionately treated by new surgeons.

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Impact of Surgeon Experience During Carotid Endarterectomy Operation and Effects on Perioperative Outcomes

Cited by 3 publications

References 18 publications

High Mini-Skin Incision during Carotid Endarterectomy for Carotid Stenosis

High Mini-Skin Incision during Carotid Endarterectomy for Carotid Stenosis

Outcomes after Transverse-Incision ‘Mini’ Carotid Endarterectomy and Patch-Plasty

A National Comparison of Operative Outcomes of New and Experienced Surgeons

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