Infrainguinal bypass grafting for critical ischaemia in the hands of trainees

Background: Changes in surgical training mean that operative experience must be gained more efficiently. However, it is important to demonstrate that increasing training opportunities are not associated with inferior patient outcome. The immediate and long‐term outcomes of patients undergoing infrainguinal bypass surgery by consultants and trainees were compared. Methods: A prospectively gathered database of 1077 infrainguinal bypasses performed on 1003 patients for chronic critical limb ischaemia between 1 January 1983 and 31 December 1998 in a single regional vascular unit was evaluated. Results: Consultants performed 733 operations (68·1 per cent), 347 (47·3 per cent) above‐knee, 257 (35·1 per cent) below‐knee popliteal, 121 (16·5 per cent) crural and eight (1·1 per cent) other procedures. Of 344 trainee operations, 170 (49·4 per cent) were above‐knee, 122 (35·5 per cent) below‐knee, 48 (14·0 per cent) crural and four (1·2 per cent) other operations. There was no significant difference in 30‐day mortality rate between consultant (2·8 per cent) and trainee (2·0 per cent) operations, nor was there any significant difference in patency or limb salvage rates at 36 months ( Table ). There was a trend towards reduced graft patency in trainee crural bypasses but this was not statistically significant (35·9 versus 56·2 per cent; P = 0·14, log rank test).Synthetic Synthetic + vein cuff VeinConsultant  3‐year patency (%) 50·0 ( n = 234) 54 ( n = 83) 64·9 ( n = 416)  Limb salvage (%) 68·2 ( n = 234) 73 ( n = 83) 78·3 ( n = 416) Trainee  3‐year patency (%) 59·1 ( n = 105) 42 ( n = 55) 67·7 ( n = 184)  Limb salvage (%) 3·8 ( n = 105) 59 ( n = 55) 82·7 ( n = 184)Conclusion: These data suggest that, with appropriate case selection and supervision, training in femoropopliteal and crural bypass grafting does not compromise early or long‐term outcome. © 2000 British Journal of Surgery Society Ltd