A. B. Nordin1, M. M. Wach1, C. A. Cooper1,2, J. M. Jordan1,2 1State University Of New York At Buffalo,General Surgery,Buffalo, NY, USA 2Erie County Medical Center,Trauma And Acute Care Surgery,Buffalo, NY, USA
Introduction:
Nonoperative management has become increasingly recommended for solid organ injury, particularly for lower grade injuries, given that multiple studies have demonstrated improved outcomes and decreased morbidity by potentially avoiding a major operation. These changing treatment paradigms, along with reduced resident work hours, have significant potential to impact resident operative experiences in solid organ trauma. We sought to examine and quantify changes in resident operative experience in solid organ injury over time.
Methods:
We utilized American College of Graduate Medical Education (ACGME) case log reports over a 15-year period from 2003 to 2018. Reported total case volumes in the categories of non-operative trauma, trauma laparotomy, splenectomy/splenorrhaphy, and hepatic repair/resection were examined. The overall study period was divided into five equal 3-year groups, and the average case numbers over this period were compared within each category to a significance of p < 0.05.
Results:
Over the study period, non-operative trauma cases increased from an average of 34.1 to 55.7 cases (p = 0.007). When sequential time periods were compared, the largest increase in average non-operative case numbers was seen from 2006-2009 to 2009-2012 (42.6 vs 47.2, p = 0.004). During the overall period, average operative splenic trauma cases decreased from 3.2 to 2.1 (p <0.001), and average operative hepatic trauma cases decreased from 2.0 to 1.5 (p = 0.001). Interestingly, despite the decline in operative solid organ trauma and the rising number of non-operative trauma cases, the average number of trauma laparotomies increased significantly over this time (4.9 vs 8.6; p < 0.001).
Conclusion:
: Increases in nonoperative solid organ injury management correlates with decreased experience in solid organ operative trauma for surgical residents. While nonoperative management has documented benefits for patients, our results imply that such management may adversely impact trainee experience, especially when these procedures need to be performed emergently. To that end, residents may benefit from simulation or skills labs to augment their experience and give adequate preparation. Future work could also monitor residents’ subjective comfort level with performing these operations over time.