Mortality after open aortic aneurysm surgery by Australasian surgeons trained in the endovascular era

Background: Reduced exposure of trainees to open repair (OR) of abdominal aortic aneurysm (AAA) during training has been considered detrimental to outcome. The Australasian experience is examined.

Methods: The Australasian Vascular Audit (AVA) was interrogated for AAA procedures between 1 January 2010 and 31 December 2014. Surgeons completing training before 2006 (group 1) were compared with those attaining their qualification subsequently (group 2). The Australian Institute of Health and Welfare (AIHW) database was also interrogated to confirm the trends over time of open and endovascular repair (EVAR) since 2000. Actual exposure to OR and EVAR of AAA by trainees from 2010 to 2014 was also extracted.

Results: One hundred and forty-six surgeons in group 1 performed 3049 OR compared with 997 for the 66 surgeons in group 2. Overall mortality for group 1 was 9.8% and for group 2, 15% (P < 0.0001). However, proportionately more ruptured AAA were treated in group 2 (31.5%) compared to group 1 (21.6%) (P < 0.0001). There was a slightly higher mortality in group 2 for ruptured but not intact aneurysm repair. Logistic regression analysis did not show the consultant group to be a significant variable in the model. EVAR was performed in 7409 patients during the study period; group 1 had a 1.5% mortality rate compared with 1.6% for group 2 (P = 0.76). AIHW data showed a trend of increasing EVAR with time. Considerable variation in OR exposure by trainees exists.

Conclusion: Reduced exposure to OR by younger trainees did not significantly affect surgical outcome when compared with those surgeons trained in an earlier period.