Effect of supervised surgical training provided to general surgery residents on clinical maturation of arteriovenous fistula surgery: A retrospective cohort study

Introduction: With the advent of endovascular technique and the emergence of vascular surgery as a separate branch distinct from general surgery, there is a decrease in exposure of open vascular technique to general surgery resident. Vascular access surgery is a vascular subspecialty area and not all residents get similar exposure during training, and this has implications if one becomes a vascular consultant in the future and have to undertake access surgery. There is no established protocol or duration, following which a surgical resident can be named as "trained" in vascular anastomosis. Our study tries to address the aforementioned problems; in particular the actual training that a general surgery resident needs in vascular access.

Objective: To study and compare the outcomes of AV Fistula surgeries, created by "trained" general surgical residents and consultant.

Method: A single-institution retrospective cohort study comparing two groups of cohorts: trained residents (group A) and consultant (group B). Study has been done in accordance with the standards of ICMJE and registered with the Clinical Trial Registry of India. (CTRI/2021/12/038581).

Result: Out of 238 patients recruited, 157 underwent surgery in group 'A' (the trained residents performing arteriovenous fistula surgery) and 81 underwent surgery in group 'B' (by consultant of general surgery). Clinical maturation noted after 8 weeks was 83.4% (131/157) in group A and 90.1% (73/81) in group 'B'; (p = 0.113). The mean duration of surgery in group 'A' was 99.8 ± 18.2 min and group 'B' was 56.2 ± 10.4 min; (p value < 0.0001).

Conclusion: A structured training in vascular anastomosis provided to the newly recruited residents in general surgery for 6 months lead to outcomes that were comparable with the consultants.