Current guidelines produce competent endovascular surgeons
| Autor: | Haimesh Shah, Jason Q. Alexander, Steven J. Katz, Douglas B. Hood, Fred A. Weaver, Albert E. Yellin, Vincent L. Rowe |
|---|---|
| Rok vydání: | 2006 |
| Předmět: |
Adult
Male medicine.medical_specialty Faculty Medical Percutaneous Adolescent medicine.medical_treatment education Transluminal Angioplasty California Hospitals University Postoperative Complications medicine Humans cardiovascular diseases Major complication Aged Aged 80 and over business.industry General surgery Mortality rate Angioplasty Internship and Residency Stent Middle Aged Vascular surgery Surgery Benchmarking surgical procedures operative Practice Guidelines as Topic cardiovascular system Endovascular interventions Female Stents Clinical Competence Curriculum Guideline Adherence Cardiology and Cardiovascular Medicine business Complication Vascular Surgical Procedures |
| Zdroj: | Journal of Vascular Surgery. 43:992-998 |
| ISSN: | 0741-5214 |
| DOI: | 10.1016/j.jvs.2006.01.023 |
| Popis: | Objective This study was conducted to evaluate the safety of percutaneous endovascular procedures (PEPs) during integration of endovascular skills into an urban academic vascular surgery practice and assess the hypothesis that currently accepted guidelines are a valid benchmark for endovascular competency. Methods From 2000 through 2004, an endovascular training paradigm was instituted to integrate endovascular procedures into an academic endovascular practice. The paradigm involved individual mentoring of vascular surgery faculty by a partner with mature endovascular skills. Mentoring continued until each surgeon achieved a procedural experience of 100 diagnostic angiograms and 50 percutaneous endovascular interventions. Once achieved, privileges were granted for independent endovascular practice. To assess the effectiveness of the training process and competency of the newly trained endovascular practitioner, the surgeon-specific 30-day incidence of major complications and deaths for all PEPs performed during and after the mentoring process was determined. Complications and deaths were assigned to the mentor during the training process and to the individual surgeon once endovascular privileges were granted. Complications were classified as local vascular, local nonvascular, or systemic/remote. Results From 2000 through 2004, 1208 PEPs were performed. During this time, three faculty surgeons achieved sufficient endovascular procedural experience and were granted endovascular privileges. Major complications consisted of 17 local vascular, three local nonvascular, and four systemic/remote. Three deaths occurred. Renal percutaneous transluminal angioplasty/stent procedures had the highest complication and death rate at 9%. The major complication and death rate per year was 1.8% to 4.9% ( P = .32) and did not significantly vary. The major complication and death rate for all 1208 PEPs was 2.2%. The surgeon-specific complication and death rate was 1.9% to 3.6% ( P = .14) and did not vary between surgeons. Conclusion Endovascular skills can be safely transferred using a vascular surgeon-based training paradigm. When the training paradigm is directed at satisfying currently recommended guidelines for endovascular privileging, competent endovascular surgeons are the result. |
| Databáze: | OpenAIRE |
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