The impact of training on outcomes in primary vascular access surgery

Abstract

Background: There is evidence that the outcome of arteriovenous fistula surgery is dependent on the surgeon performing the operation. Vascular access surgery provides excellent technical training for surgical trainees. The effect of surgical trainees on the outcome of fistulas was evaluated. Methods: The grade of the main operator for all first attempted (primary) upper limb arteriovenous fistulas, between February 1998 and August 2001, was identified. Median follow-up was 18.0 months (IQR, 6.5-30.1 months). Successful use of fistula for dialysis, fistula patency and survival were assessed. Results: 441 primary fistulas were formed in the study period. Median age was 67.5 years (IQR, 54.0-75.2 years). 71% of all fistulas were formed at the wrist. Trainees performed 31.1% of all operations. The two groups (trainees and consultants) were well matched for age, sex, diabetes, and fistula type. Only 70.5% of patients proceeded to long-term haemodialysis. There were no significant differences in the successful use of AVF for dialysis or patency rates between the two groups. One and two year fistula survival in this group was 87.7% and 78.3% for trainees and 80.8% and 71.1% for consultants (P = 0.288 log rank). Conclusions: Surgical trainees can perform primary AVF surgery without significantly reducing fistula outcomes. Vascular access surgery can be utilised as a training operation.

Impact of Intraoperative and 24h Blood Pressure Levels and Presence of Arteriosclerosis on Arteriovenous Fistula

“…MacAskill et al and Kim et al stated in their studies that preexisting or incoming intimal hyperplasia was an important factor in AVF survival. On the other hand, the existence or absence of arteriosclerosis in the artery used for anastomosis was considered, which is similar to the study of Parmer et al, both on physiological and mechanical basis [6,11,12,15] .…”

“…Also, immediate and long-term success of a newly constructed AVF depends on several hemodynamic factors, vessel characteristics, and surgeon experience [3][4][5][6][7][8][9][10][11][12][13][14][15][16] . MacAskill et al and Kim et al stated in their studies that preexisting or incoming intimal hyperplasia was an important factor in AVF survival.…”

“…Accordingly, AVF creation and long-term patency are of paramount importance for patients waiting for renal transplantation. The factors influencing the patency of AVF, such as diabetes mellitus (DM) [3] , previous heparin use [4] ,C-reactive protein [5] , preexisting intimal hyperplasia [6] , intraoperative blood flow measurements [7] , presence of malignancy, previous central venous catheter (CVC) insertion, preoperative arterial blood pressure (ABP), arterial inflow (AI), subclavian venous flow (SVF), operative venous outflow of the fistula [8] , hypertension, smoking [3,9,10] , reoperative radial arterial diameter [11] , surgeon experience [12] , have been explored.…”

Vascular Access for Hemodialysis - How to Maintain in Clinical Practice

“…Surgical experience: There can be little doubt that experienced surgeons with adequate training have good outcomes [103], but well supervised trainees can produce equivalent results [114].…”

The role of surgical trainees in overseas surgical missions

“…Various studies examining the outcomes of procedures in tertiary institutions performed by well‐supervised surgeons in training showed similar outcomes to consultant‐alone performed procedures 1–5 . Within an appropriate framework, this model may also be applied effectively overseas.…”