Are the National Procedure Trends for Training in Vascular Surgery Indicative of the Current Status in Vascular Surgery

Robert B. McLafferty, MD, Aamir A. Zakaria, MD, Colleen Johnson, MD, Don E. Ramsey, MD and Kim J. Hodgson, MD
Vascular Surgery, Southern Illinois University, Springfield, IL

Objective: To examine the national average (NA) trends for vascular surgery trainees performing open and endovascular procedures (OPs, EPs) compared to a single training institution (SI).
Methods: From 1999 - 2005, comparisons of specific OP and EP categories were made between the national vascular RRC data set and a SI vascular surgery two-year training program with one vascular fellow per year. EP categories were designated as EVAR, diagnostic, and therapeutic.
Results: There was a significant increasing trend over 7 years for combined OPs and EPs for the NA and SI (p<0.001). For 1999, 2000, and 2001, the proportion of EPs to all procedures by SI was significantly lower compared to NA (1.5% vs. 5.3%, p = 0.03; 0.5% vs. 5.2%, p=0.01; 7.8% vs. 21.3%, p=0.01). For 2002 and 2003, the proportion of EPs to all procedures by SI was significantly higher than NA (37.8% vs. 30.4%, p=0.04; 47.6% vs. 37%, p=0.01). For 2004 and 2005, EP proportion for SI continued to trend higher compared to NA (49.7% vs. 43.6%, p=0.07; 53.5% vs. 48.0%, p=0.07). The Table illustrates that despite a dramatic increase in SI therapeutic EPs, OPs in peripheral obstructive continued to be higher than NA for the last 5 years. The 7 year trend for cerebrovascular OPs increased for SI and decreased for NA. The figure shows trends of OPs and EPs for SI and NA over 7 years. There was a decreasing trend of general surgery residents performing all vascular OPs over seven years for SI and NA.
Conclusion: Interpretation of means of OPs and EPs in vascular surgical training using the national data set may be misleading. Trend measurements of how each SI differs from the NA may be more indicative of the current status of strengths and weaknesses in vascular surgery training. SI procedure trends rather than NAs remain vital to potentially attracting future trainees to vascular surgery.