Key result
Protocol-guided CEA by beginner surgeons shows similar 30-day mortality and morbidity to expert surgeons.
Why the study?
Does carotid endarterectomy performed by beginner surgeons using a defined protocol result in comparable 30-day mortality and morbidity compared to expert surgeons?
Observational (n=268)
No
Does carotid endarterectomy performed by beginner surgeons using a defined protocol result in comparable 30-day mortality and morbidity compared to expert surgeons?
A defined protocol for carotid endarterectomy allows beginner surgeons to achieve low 30-day mortality and morbidity rates that are comparable to those of expert surgeons.
Supports protocol use by beginner CEA surgeons; hypothesis-generating and should not yet change practice.
In April 2008, carotid artery stenting (CAS) was approved for high-risk candidates for carotid endarterectomy (CEA) in Japan, a difficult procedure for young neurosurgeons. From January 2001 to March 2008, in our hospital, CEA was performed on 68 vessels by 2 expert surgeons and 234 vessels by 10 beginner surgeons with a defined protocol. This protocol includes propofol anesthesia with electroencephalography (EEG) and somatosensory evoked potential (SEP) monitoring, the avoidance of an intraluminal shunting, brain protection, and strict control of postoperative hypertention. At 30 days, combined permanent mortality and morbidity rate was 2.9% in the experts’ group and 0.9% in the beginners’ group. We report a series of 302 consecutive CEAs performed by 2 expert and 10 beginner surgeons within a defined protocol and the results.
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Nakashima et al. (2009) conducted an observational in Carotid artery stenosis (n=268). CEA performed by beginner surgeons vs. CEA performed by expert surgeons was evaluated on Combined permanent mortality and morbidity rate at 30 days (p=NS). Carotid endarterectomy performed by beginner surgeons using a defined protocol resulted in a 30-day combined mortality and morbidity rate of 0.9%, compared to 2.9% for expert surgeons, with no significant difference.
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