Arteriovenous fistula formations: Key to vascular surgical training
Purpose: To highlight missed training opportunities in daycase surgery for trainees to acquire competency in vascular anastomosis by performing arteriovenous fistula (AVF) formations.
Methods: Operative Room Management Information System records were reviewed for AVF procedures in daycase and general theatres at a UK Foundation Trust between 2007 and 2012. Data collected included procedure, procedure time (PT), patient length of stay (LOS), readmissions within 30 days of procedure and lead and assistant surgeons involved.
Results: Of 199 daycase AVF procedures reviewed, 59.3% (n=118) were brachiocephalic formations and 34.2% (n=68) radiocephalic formations. Trainees attended 41.2% of daycase AVF procedures and were lead surgeon in 7.3% of these. Mean PT was 64 minutes for consultants compared with 56 minutes for trainees, with no significant difference (p=0.297). Median patient LOS was less than 24 hours for both groups. Six daycase AVF procedures resulted in patient readmission within 30 days; five of these were operated on by consultants and one by a staff grade. During the same period, 258 AVF procedures were performed in general theatres. Trainees attended 64.3% of AVF formations performed in general theatres and were lead surgeon in 5.8% of these.
Conclusions: Trainees attended and led few daycase AVF formations despite no significant difference in PT, patient LOS or readmission rate between consultant-led and trainee-led cases. Trainees attended more AVF formations performed in general theatres than daycase. However, trainees led a greater proportion of daycase AVF formations, possibly due to a less complex case mix that is more suitable for training.
J Vasc Access 2014; 15(1): 18 - 21
Article Type: ORIGINAL RESEARCH ARTICLE
Article Subject: Dialysis
Ahmed M. El-Sharkawy, Daniel L.J. Morris, Balvinder S. Grewal, John W. Quarmby, Timothy E. Rowlands
• Accepted on 19/06/2013
• Available online on 02/09/2013
• Published in print on 11/03/2014
Financial support: None.
Conflict of interest: Some of the authors are doctors in training.
You will be granted access to the article for 72 hours and you will be able to download any format (PDF or ePUB). The article will be available in your login area under "My PayPerView". You will need to register a new account (unless you already own an account with this journal), and you will be guided through our online shop. Online purchases are paid by Credit Card through PayPal.