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Kim Y, Cui CL, Williams ZF, Long CA. Impact of Integrated Vascular Surgery Residency on General Surgery Resident and Vascular Fellow Operative Volume: A National Analysis. Vasc Endovascular Surg 2024; 58:302-307. [PMID: 37918823 DOI: 10.1177/15385744231213299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
BACKGROUND The impact of integrated vascular surgery (VS) residency (0 + 5) programs on general surgery (GS) resident and VS fellow (5 + 2) operative volume has not been investigated on a national scale. METHODS Accreditation Council for Graduate Medical Education (ACGME) case logs were reviewed for GS resident, VS resident, and VS fellow operative volume from 2001-2021. Integrated VS resident data was available from 2012-2021, corresponding with the introduction of the 0 + 5 paradigm. Trends in operative volume were evaluated via linear regression analysis. RESULTS The national cohort of chief GS resident graduates increased from 1005 to 1357 per year. Total operative volume also increased from 932 to 1039 cases (+7.4 cases/yr, R2 = .80, P < .0001) among GS residents. Major vascular cases decreased among GS residents from 138 to 101 cases (-2.4 cases/yr, R2 = .58, P < .0001) with a decrease in proportion of chief-level vascular cases from 30.4% to 11.9% (-1.0%/yr, R2 = .92, P < .0001). Palliative procedures (amputations and hemodialysis access) comprised a significant proportion of GS cases (median 44.7%). Concurrently, integrated VS graduates increased from 11 to 37 per year, with an increase in major vascular case volume from 506 to 658 cases (+18.4 cases/yr, R2 = .63, P = .01). Total VS fellow major case volume also increased from 369 to 444 cases (+3.5 cases/yr, R2 = .73, P < .0001). CONCLUSIONS The introduction of the 0 + 5 intgrated VS residency paradigm has correlated with a significant decrease in GS operative experience in major vascular procedures on a national level. Traditional VS fellow case volume does not appear to be impacted by 0 + 5 integrated residents. Further analysis with program-level data may help to explain the causative relationship of these findings.
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Affiliation(s)
- Young Kim
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Durham, NC, USA
| | - Christina L Cui
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Durham, NC, USA
| | - Zachary F Williams
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Durham, NC, USA
| | - Chandler A Long
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Durham, NC, USA
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Blitzer D, Benintende AJ, Nemeth S, Kurlansky P, Antkowiak M, Fischkoff K, Argenziano M, Takayama H. Trends in Comprehensive Thoracic Case Experience Among General Surgery Residents in the Modern Integrated Cardiothoracic Residency Era: Review of Twenty Years of Resident Case Logs. Am Surg 2023; 89:5512-5519. [PMID: 36797046 DOI: 10.1177/00031348231157417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND Thoracic surgery training among general surgery residents in the United States is regulated by the Accreditation Council for Graduate Medical Education (ACGME) to ensure exposure to subspecialty fields during residency. Thoracic surgery training has changed over time with the placement of work hour restrictions, the emphasis on minimally invasive surgery, and increased subspecialization of training like integrated six-year cardiothoracic surgery programs. We aim to investigate how these changes over the past twenty years have affected thoracic surgery training among general surgery residents. METHODS ACGME general surgery resident case logs from 1999 to 2019 were reviewed. Data included exposure to the thorax via thoracic, cardiac, vascular, pediatric, trauma, and alimentary tract procedures. Cases from the above categories were consolidated to determine the comprehensive experience. Descriptive statistics were performed over four 5-year Eras (Era 1:1999-2004, Era 2: 2004-2009, Era 3: 2009-2014, Era 4: 2014-2019). RESULTS Between Era 1 and Era 4, there was an increase in thoracic surgery experience (37.6 ± 1.03 vs 39.3 ± .64; P = .006). The mean total thoracic experience for thoracoscopic, open, and cardiac procedures was 12.89 ± 3.76, 20.09 ± 2.33, and 4.98 ± 1.28, respectively. There was a difference between Era 1 and Era 4 in thoracoscopic (8.78 ± .961 vs 17.18 ± .75; P < .001) and open thoracic experience (22 ± .97 vs 17.06 ± .88; P < .001), and a decrease in thoracic trauma procedures (3.7 ± .06 vs 3.2 ± .32; P = .03). DISCUSSION Over twenty years there has been a similar, to slight increase in thoracic surgery exposure among general surgery residents. The changes seen in thoracic surgery training reflect the overall movement of surgery towards minimally invasive surgery.
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Affiliation(s)
- David Blitzer
- Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Andrew J Benintende
- Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Samantha Nemeth
- Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Paul Kurlansky
- Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Mark Antkowiak
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Katherine Fischkoff
- Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Michael Argenziano
- Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Hiroo Takayama
- Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
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Gallagher S, Sozzi M, Gallegos H, Ugarte C, Park S, Schellenberg M, Matsushima K, Magee GA, Inaba K, Martin M. Epidemiology and outcomes of traumatic vascular injury repair by trauma surgeons and vascular surgeons in a collaborative model. J Trauma Acute Care Surg 2023; 95:628-634. [PMID: 37012627 DOI: 10.1097/ta.0000000000003975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
BACKGROUND Management roles for peripheral vascular injuries (PVI) are a source of ongoing debate given the concern for the loss of vascular skills among general surgeons and trauma surgeons (TS). We sought to analyze outcomes of PVI managed by TSs or vascular surgeons (VSs). METHODS This is a retrospective study of a single, Level I trauma center. Trauma patients with PVI who underwent repair from 2010 to 2021 were included. Patients were separated into groups by the surgical specialty (TS or VS) undertaking the first intervention of the injured vessel. RESULTS A total of 194 patients were included, with 101 (52%) PVI managed by TS and 93 (48%) by VS. The TS group had more penetrating injuries (84% vs. 63%, p < 0.01), were more often hypotensive (17% vs. 6%, p = 0.01), and had a higher median Injury Severity Score (10 vs. 9, p < 0.001). Time from arrival to operating room was lower in the TS group (77 vs. 257 minutes, p < 0.01), with no difference in rates of preoperative imaging. The TS group performed damage-control surgery (DCS) more frequently (21% vs. 1.1%, p < 0.01). There was no difference in reintervention rates between the two groups after excluding patients that required reintervention for definitive repair after DCS (13% vs. 9%, p = 0.34). Mortality was 8% in the TS group and 1% in the VS group ( p = 0.02) with no deaths related to the PVI repair in either group. There was no difference in PVI repair complication rates between the two groups (18% vs. 13%; p = 0.36). CONCLUSION In our collaborative model at a high-volume trauma center, a wide variety of PVI are surgically managed by TS with VS. immediately available for consultation or for definitive repair of more complex vascular injuries. Trauma surgeons performed more DCS on higher acuity patients. No difference in vascular-related complications was detected between groups. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level IV.
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Affiliation(s)
- Shea Gallagher
- From the Division of Trauma and Acute Care Surgery, Department of Surgery (S.G., M.S., H.G., C.U., S.P., M.S., K.M., K.I., M.M.), and Division of Vascular Surgery, Department of Surgery (G.A.M.), LAC+USC Medical Center, Los Angeles, California
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4
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Osofsky R, Hanif H, Massie P, Ramey S, Miskimins R, Clark R, Rana MA, Guliani S. Vascular Surgery Role in Vascular Trauma: 11-Year Analysis of Peripheral Vascular Trauma Management at a Level-1 Trauma Center. Ann Vasc Surg 2023:S0890-5096(23)00101-2. [PMID: 36805425 DOI: 10.1016/j.avsg.2023.01.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/04/2023] [Accepted: 01/26/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Vascular surgeons are increasingly relied upon in the management of complex peripheral vascular trauma. The degree however that vascular surgery (VS) is involved in vascular trauma care is not well established. We hypothesize that VS consultation is required in a high portion of complex lower extremity vascular trauma. METHODS A single-center retrospective review of all consecutive patients who sustained traumatic arterial injury of the lower extremity requiring open operative repair at a level-1 trauma center (from February 2009 to May 2020) was performed. Patients who underwent surgical repair were stratified by the service that performed the operation (VS versus trauma surgery [TS]). Secondary outcomes assessed included location of arterial injury, type of repair, and clinical outcomes. RESULTS A total of 111 patients underwent operative repair of lower extremity arterial injury (mean age 34.5 ± 15.5 years, 89% male). The most common vessels requiring intervention were the superficial femoral artery (n = 42, 38%), popliteal artery (n = 35, 31.5%), and tibial vessels (n = 19, 17.1%). The most common intervention required in patients was an autologous bypass (n = 85, 76.5%), followed by ligation (n = 9, 8.1%) and primary repair (n = 6, 5.4%). Most interventions overall required VS involvement (n = 95, 86%). VS performed a higher proportion of autologous graft procedures compared to TS (n = 79, 92.9% vs. n = 6, 7.1%). VS case load overall was likewise predominantly autologous grafts (n = 79/95, 83.2%). TS operated on a higher proportion of injuries to the tibial vessels (44% vs. 13%, P = 0.01), whereas VS intervened more frequently on popliteal injuries (36% vs. 6%, P = 0.02). With regard to the method of arterial repair, TS was more likely to perform ligation (38% vs. 3 %, P < 0.001) or primary repair (13% vs. 3%, P = 0.04) compared to VS. However, VS was more likely to perform repair with autologous graft (83% vs. 38%, P < 0.001). There were no significant differences in rates of mortality, limb loss, transfusions requirement, fasciotomy, deep venous thrombosis, hematoma formation, or length of stay between groups. Although, surgical site infections were more common in the TS group (38% vs. 15%, P = 0.04). CONCLUSIONS Vascular surgeons play a large role in managing complex lower extremity vascular trauma. In particular, VS remains integral for the management of more difficult injuries (e.g., popliteal injuries) and is more likely to provide more complex repairs (e.g., autologous grafts).
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Affiliation(s)
- Robin Osofsky
- Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM
| | - Hamza Hanif
- Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM.
| | - Pierce Massie
- Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM
| | - Shannen Ramey
- Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM
| | - Richard Miskimins
- Division of Acute Care Surgery, University of New Mexico School of Medicine, Albuquerque, NM
| | - Ross Clark
- Division of Vascular Surgery, University of New Mexico School of Medicine, Albuquerque, NM
| | - Muhammad Ali Rana
- Division of Vascular Surgery, University of New Mexico School of Medicine, Albuquerque, NM
| | - Sundeep Guliani
- Division of Acute Care Surgery, University of New Mexico School of Medicine, Albuquerque, NM; Division of Vascular Surgery, University of New Mexico School of Medicine, Albuquerque, NM
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Hatcher AJ, West AB, Rajani RR, Ramos CR, Benarroch-Gampel J. Vascular surgery is the most commonly consulted specialty for emergent operative trauma. J Vasc Surg 2023; 77:63-68.e1. [PMID: 35944734 DOI: 10.1016/j.jvs.2022.07.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/01/2022] [Accepted: 07/19/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Despite an increasing rate of intraoperative consultation of vascular surgery (VS) for trauma patients, VS is not one of the subspecialties required for American College of Surgeons level I trauma center verification. We sought to assess the rates and patterns of emergent operative VS consultation compared with other surgical subspecialties in the trauma setting. METHODS A retrospective analysis was performed on all patients who presented with traumatic injuries requiring emergent surgical operations (<3 hours after presentation) from 2015 to 2019 at a level I trauma center. Patient demographics, injury characteristics, and data on consulted surgical subspecialties were collected. The primary outcome measured was the rate of intraoperative consultation to VS and other subspecialties (OS). RESULTS A total of 2265 patients were identified, with 221 emergent intraoperative consults to VS and 507 consults to OS. After VS (9.8%), the most common subspecialties consulted were orthopedics (9.2%) and urology (5%). Overall, VS was more likely to be consulted in immediate trauma operations (<1 hour after presentation) (65.6% vs 38.1%, P < .0001), penetrating injuries (73.3% vs 47.9%, P < .0001), and at night (60.6% vs 51.9%, P = .02) compared with OS. Time from admission to operation was shorter for cases when VS was involved compared with OS (54.1 ± 40.4 vs 80.6 ± 47.9 minutes, P < .0001). In a multivariable logistic regression model, we found that requiring an immediate operation was associated with higher odds of requiring an intraoperative vascular consult (odds ratio = 1.49, 95% confidence interval = 1.12-2.0). CONCLUSIONS Vascular surgeons are consulted intraoperatively to assist with emergent trauma at a greater rate compared with specialties that are required for level I trauma center verification. Current American College of Surgeons verification processes and site-specific policies should be re-evaluated to consider VS coverage as a requirement for trauma center verification.
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Affiliation(s)
| | - Anna Beth West
- Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Ravi R Rajani
- Division of Vascular Surgery and Endovascular Therapy, Emory University School of Medicine, Atlanta, GA; Grady Memorial Hospital, Atlanta, GA
| | - Christopher R Ramos
- Division of Vascular Surgery and Endovascular Therapy, Emory University School of Medicine, Atlanta, GA; Grady Memorial Hospital, Atlanta, GA
| | - Jaime Benarroch-Gampel
- Division of Vascular Surgery and Endovascular Therapy, Emory University School of Medicine, Atlanta, GA; Grady Memorial Hospital, Atlanta, GA.
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Manohar M, Pol MM, Winston B, Chauhan A, Jarapala V, Sahir M. Effect of supervised surgical training provided to general surgery residents on clinical maturation of arteriovenous fistula surgery: A retrospective cohort study. Ann Med Surg (Lond) 2022; 82:104780. [PMID: 36268433 PMCID: PMC9577963 DOI: 10.1016/j.amsu.2022.104780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/19/2022] [Accepted: 09/19/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Manav Manohar
- Corresponding author. Department of Surgical Disciplines, CMET, teaching block, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 29, India.
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7
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Cortez AR, Ibáñez B, Jones AT, Valentine RJ, Potts JR. Contemporary Practice of General Surgery in the US: Analysis of American Board of Surgery Diplomate Case Logs. J Am Coll Surg 2022; 235:17-25. [PMID: 35703958 DOI: 10.1097/xcs.0000000000000202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The demographics and operative experience of general surgeons certified by the American Board of Surgery were last examined a decade ago. This study examines the contemporary workforce and scope of practice of general surgeons. STUDY DESIGN Applications of diplomates seeking American Board of Surgery recertification from 2013 to 2017 were reviewed. Demographic data and case logs from the year before submission were analyzed. Total operative volume was examined, as were total volumes for 13 operative domains and 11 abdominal and alimentary tract subdomains. RESULTS There were 4,735 general surgeons certified by the American Board of Surgery with a mean ± SD age of 53 ± 8 years and included 19% women and 14% international graduates. Regions of practice were 22% Northeast, 31% Southeast, 20% Midwest, 20% West, and 7% Southwest. Practice settings were 86% urban, 9% large rural, 4% small rural, and 1% isolated. Forty-one percent were 10 years, 35% were 20 years, and 24% were 30 years since initial certification. On average, general surgeons performed 417 ± 338 procedures per year, with abdominal, alimentary tract, and endoscopy being the most common. On multivariable analysis, male sex and being midcareer or late career were positively associated with being a high-volume (top quartile) surgeon, whereas age and practicing in either the Northeast or West demonstrated a negative association. CONCLUSIONS The demographics of general surgeons have remained stable over time, except for an increased proportion of female surgeons. The overall operative experience is similar to years past but is widely variable between surgeons. Periodic analysis of these data is important for education and certification purposes.
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Affiliation(s)
- Alexander R Cortez
- From the Cincinnati Research on Education in Surgical Training, Department of Surgery, University of Cincinnati, Cincinnati, OH (Cortez)
| | - Beatriz Ibáñez
- the American Board of Surgery, Philadelphia, PA (Ibáñez, Jones)
| | - Andrew T Jones
- the American Board of Surgery, Philadelphia, PA (Ibáñez, Jones)
| | - R James Valentine
- the Department of Surgery, University of Minnesota, Minneapolis, MN (Valentine)
| | - John R Potts
- Superior Value in Program Accreditation, Chicago, IL (Potts)
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8
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Karam BS, Haberman K, Nguyen P, Eddine SBZ, Boyle K, Baskaran A, Figueroa J, Milia D, Carver T, Somberg L, Webb T, Davis CS, Dodgion C, Elegbede A, de Moya MA. Trauma surgeon-performed peripheral arterial repairs are associated with equivalent outcomes when compared with vascular surgeons. J Trauma Acute Care Surg 2022; 92:754-759. [PMID: 35001022 DOI: 10.1097/ta.0000000000003531] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Civilian extremity trauma with vascular injury carries a significant risk of morbidity, limb loss, and mortality. We aim to describe the trends in extremity vascular injury repair and compare outcomes between trauma and vascular surgeons. METHODS We performed a single-center retrospective review of patients 18 years or older with extremity vascular injury requiring surgical intervention between January 2009 and December 2019. Demographics, injury characteristics, operative course, and hospital course were analyzed. Descriptive statistics were used to examine management trends, and outcomes were compared for arterial repairs. Multivariate regression was used to evaluate surgeon specialty as a predictor of complications, readmission, vascular outcomes, and mortality. RESULTS A total of 231 patients met our inclusion criteria; 80% were male with a median age of 29 years. The femoral vessels were most commonly injured (39.4%), followed by the popliteal vessels (26.8%). Trauma surgeons performed the majority of femoral artery repairs (82%), while vascular surgeons repaired the majority of popliteal artery injuries (84%). Both had a similar share of brachial artery repairs (36% vs. 39%, respectively). There were no differences in complications, readmission, vascular outcomes, and mortality. Median time from arrival to operating room was significantly shorter for trauma surgeons. There was a significant downward trend between 2009 and 2017 in the proportion of total and femoral vascular procedures performed by trauma surgeons. On multivariate regression, surgical specialty was not a significant predictor of need for vascular reintervention, prophylactic or delayed fasciotomies, postoperative complications, or readmissions. CONCLUSION Traumas surgeons arrived quicker to the operating and had no difference in short-term clinical outcomes of brachial and femoral artery repairs compared with patients treated by vascular surgeons. Over the last decade, there has been a significant decline in the number of open vascular repairs done by trauma surgeons. LEVEL OF EVIDENCE Therapeutic/Care Management, Level IV.
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Affiliation(s)
- Basil S Karam
- From the Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
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9
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Harfouche MN, Kauvar DS, Feliciano DV, Dubose JJ. Managing Vascular Trauma: Trauma Surgeons versus Vascular Surgeons. Am Surg 2022; 88:1420-1426. [DOI: 10.1177/00031348221080427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives Changes in vascular trauma care and trainee exposure to vascular surgery have raised questions regarding who should take care of vascular trauma patients. This study aimed to determine nationwide trends and perceptions regarding the management of vascular trauma amongst vascular and trauma surgeons. Material and Methods Online surveys were administered to trauma surgeons through the American Association for the Surgery of Trauma (AAST) and to vascular surgeons through the Vascular and Endovascular Surgery Society (VESS) and Western Vascular Society (WVS) in February 2021. Demographics, practice-related information, and interest in, experience and comfort level with vascular trauma were queried. Trainees and those practicing outside the United States were excluded. Results were analyzed using Stata/BE v16.1. Results 247 surgeons were included in the final study population, of which 163 (66%) were trauma surgeons (T) and 84 (34%) were vascular surgeons (V). Vascular surgeons were younger (46 v 51y, P < .001) and had fewer years in practice (10 v 17y, P < .001). Vascular surgeons had greater experience and comfort with managing vascular trauma, but less interest in both vascular and endovascular trauma care when compared to trauma surgeons. Inability to maintain skillset (27%) and unfamiliarity with techniques (32%) were the most common barriers to practicing vascular trauma cited by trauma surgeons. Discussion Despite significant interest in practicing vascular trauma amongst trauma surgeons compared to vascular surgeons, most feel unprepared to do so. Collaboration between vascular and trauma surgeons could close the experience gap and appeal to the interests of both groups.
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Affiliation(s)
- Melike N Harfouche
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - David S Kauvar
- Vascular Surgery Service, Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | - David V Feliciano
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Joseph J Dubose
- Department of Surgery, Dell Medical School, University of Texas at Austin, Austin, TX, USA
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Jackson TN, Wheeler TP, Truitt MS, Nelson PR, Kempe K. Recruitment of General Surgery Residents into Vascular Surgery. JOURNAL OF SURGICAL EDUCATION 2022; 79:165-172. [PMID: 34301522 DOI: 10.1016/j.jsurg.2021.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/04/2021] [Accepted: 07/02/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Vascular surgery fellowship applications among general surgery residents have declined. Given this steady downward trend in vascular applicants in conjunction with a predicted critical shortage of vascular surgeons, a call to action for increased recruitment is needed. To improve recruitment efforts, a subgroup analysis of general surgery residents was performed to explore factors that influence interest in vascular surgery. METHODS A cross-sectional national survey of residents (n = 467) was conducted from September 2016 to May 2017. In addition to collection of demographic and occupational characteristics, assessment of psychological, work-life balance, and job-satisfaction variables were obtained. Residents were grouped based on their interest in pursuing a fellowship. Chi-squared and Fisher's exact test was performed to determine significant variables. RESULTS Residents were grouped into "interest in non-vascular fellowship" (n = 350), "interest in vascular fellowship" (n = 21), and "not interested in fellowship" (n = 96). Significant variables between the groups included age, geographic location, residency size, and type of institution (p < 0.05). Those interested in vascular surgery tended to be older. Residents not interested in fellowship were more commonly located in the Midwest and at smaller, community residencies. No significant difference was found between mental wellness and work-life balance variables. Those residents interested in a vascular surgery fellowship were more dissatisfied with their current salary as compared to other residents (p = 0.021). CONCLUSIONS There is a predicted critical shortage in the vascular surgery workforce making recruitment of the best and brightest residents into the specialty vital to its future. In order to invigorate and broaden our group of vascular surgeons, focused recruitment of younger, Midwest, general surgery residents at smaller, community programs may provide the most yield. Publicizing the strengths of a vascular surgery career including the diversity of patients, continuity of care, proficiency in technical skill, and higher monetary rewards should be emphasized in recruiting these target populations.
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Affiliation(s)
- Theresa N Jackson
- Department of General Surgery, University of Oklahoma Tulsa, Tulsa, Oklahoma
| | - Tiffany P Wheeler
- Department of General Surgery, University of Oklahoma Tulsa, Tulsa, Oklahoma
| | - Michael S Truitt
- Department of Trauma Surgery, Methodist Dallas Medical Center, Dallas, Texas
| | - Peter R Nelson
- Department of Vascular Surgery, University of Oklahoma Tulsa, Tulsa, Oklahoma
| | - Kelly Kempe
- Department of Vascular Surgery, University of Oklahoma Tulsa, Tulsa, Oklahoma.
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11
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Li B, Rizkallah P, Eisenberg N, Forbes TL, Roche-Nagle G. Thresholds for abdominal aortic aneurysm repair in Canada and United States. J Vasc Surg 2021; 75:894-905. [PMID: 34597785 DOI: 10.1016/j.jvs.2021.08.091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 08/23/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Previous studies have demonstrated significant geographic variations in the management of abdominal aortic aneurysms (AAA) despite standard guidelines. Differences in patient selection, operative technique, and outcomes for AAA repair in Canada versus United States were assessed. METHODS The Vascular Quality Initiative was used to identify all patients who underwent elective endovascular or open AAA repair between 2010 and 2019 in Canada and the United States. Demographic, clinical, and procedural characteristics were recorded and differences between countries were assessed using independent t test and χ2 test. The primary outcome was the percentage of AAA repaired below recommended diameter thresholds (men, <5.5 cm; women, <5.0 cm). The secondary outcomes were in-hospital and 1-year mortality rates. Associations between region and outcomes were assessed using univariate/multivariate logistic regression and Cox proportional hazards analysis. RESULTS There were 51,455 US patients and 1451 Canadian patients who underwent AAA repair in Vascular Quality Initiative sites during the study period. There was a higher proportion of endovascular repairs in the United States (83.7% vs 68.4%; odds ratio [OR], 2.38; 95% confidence interval [CI], 2.13-2.63; P < .001). US patients had more comorbidities, including hypertension, congestive heart failure, chronic kidney disease, and prior revascularization. The percentage of AAA repaired below recommended thresholds was significantly higher in the United States (38.8% vs 15.2%; OR, 3.57; 95% CI, 3.03-4.17; P < .001). This difference persisted after controlling for demographic, clinical, and procedural characteristics (adjusted OR, 3.57; 95% CI, 2.63-4.17; P < .001). Factors that predicted AAA repair below recommended thresholds were US region (adjusted OR, 3.57; 95% CI, 3.03-4.17), male sex (adjusted OR, 2.89; 95% CI, 2.72-3.07), and endovascular repair (adjusted OR, 2.08; 95% CI, 1.95-2.21). The in-hospital mortality rate was low (1.0% vs 0.8%) and the 1-year rate mortality was similar between countries (hazard ratio, 0.96; 95% CI, 0.70-1.31; P = .79). CONCLUSIONS There are significant variations in AAA management between Canada and the United States. A greater proportion of US patients underwent AAA repair below the recommended diameter thresholds. This finding is partly driven by a higher percentage of endovascular repairs. Despite these differences, the perioperative and 1-year mortality rates are similar. Future studies should investigate reasons for these variations and quality improvement projects are needed to standardize care.
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Affiliation(s)
- Ben Li
- Division of Vascular Surgery, Peter Munk Cardiac Centre & University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Philippe Rizkallah
- Division of Vascular Surgery, Peter Munk Cardiac Centre & University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Naomi Eisenberg
- Division of Vascular Surgery, Peter Munk Cardiac Centre & University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Thomas L Forbes
- Division of Vascular Surgery, Peter Munk Cardiac Centre & University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Graham Roche-Nagle
- Division of Vascular Surgery, Peter Munk Cardiac Centre & University Health Network, University of Toronto, Toronto, Ontario, Canada.
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Tuma F, Malgor RD, Kapila N, Kamel MK. Trends of core versus subspecialty operative procedures completed in general surgery residency training programs. Postgrad Med J 2021; 98:772-777. [PMID: 37062995 DOI: 10.1136/postgradmedj-2021-140503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/11/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION General surgery residency involves performing subspecialty procedures in addition to the core general procedures. However, the proportion of core general surgery versus subspecialty procedures during training is variable and its temporal changes are unknown. The goal of our study was to assess the current trends in core general surgery and subspecialty procedure distributions during general surgery residency training. METHODS Data were collected from the ACGME core general surgery national resident available report case logs from 2007 to 2019. Descriptive and time series analyses were used to compare proportions of average procedures performed per resident in the core general surgery category versus the subspecialty category. F-tests were conducted to show whether the slopes of the trend lines were significantly non-zero. RESULTS The mean of total procedures completed for major credit by the average general surgery resident increased from 910.1 (SD=30.31) in 2007 to 1070.5 (SD=37.59) in 2019. Over that same period, the number of general, cardiothoracic, plastic and urology surgery procedures increased by 24.9%, 9.8%, 76.6% and 19.3%, respectively. Conversely, vascular and paediatric surgery procedures decreased by 7.6% and 30.7%, respectively. The neurological surgery procedures remain stable at 1.1 procedures per resident per year. A significant positive correlation in the trend reflecting total (p<0.0001), general (p<0.0001) and plastic (p<0.0016) surgery procedures and the negative correlation in the trend lines for vascular (p<0.0006) and paediatric (p<0.0001) surgery procedures were also noted. CONCLUSIONS Trends in overall surgical case volume performed by general surgery residents over the last 12 years have shown a steady increase in operative training opportunity despite the increasing number of subspecialty training programmes and fellowships. Further research to identify areas for improvement and to study the diversity of operative procedures, and their outcomes is warranted in the years to come.
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Affiliation(s)
- Faiz Tuma
- Central Michigan University College of Medicine, Saginaw, Michigan, USA
| | - Rafael D Malgor
- University of Colorado Denver Anschutz Medical Center Bookstore, Aurora, Colorado, USA
| | - Nikit Kapila
- General Surgery, Central Michigan University College of Medicine East Campus, Saginaw, Michigan, USA
| | - Mohamed K Kamel
- General Surgery, Central Michigan University College of Medicine East Campus, Saginaw, Michigan, USA
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St John A, Caturegli I, Kubicki NS, Kavic SM. The Rise of Minimally Invasive Surgery: 16 Year Analysis of the Progressive Replacement of Open Surgery with Laparoscopy. JSLS 2021; 24:JSLS.2020.00076. [PMID: 33510568 PMCID: PMC7810432 DOI: 10.4293/jsls.2020.00076] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective: The expansion of Minimally Invasive Surgery (MIS) has been exponential since the introduction of laparoscopic surgery in the late 1980s. This shift in operative technique has led many to believe that surgery residents are not developing the skills needed to adequately perform open operations. Methods: We performed a retrospective review of the Accreditation Council for Graduating Medical Education national operative case log database of general surgery residents from January 2003 to December 2019. We compared the open vs. laparoscopic case numbers for six different operations, including cholecystectomy, appendectomy, inguinal hernia repair, colectomy, gastrectomy, and Nissen fundoplication. The Cochran-Armitage test was used to assess the linear trend in the procedures performed. Results: Total average residency case volumes for the procedures studied have increased from 270 to 368 (36%) over the 16-year period with MIS steadily representing a greater proportion of these cases. From 2003 to 2018, MIS representation increased in all studied procedures: cholecystectomy (88% to 94%, p = 0.048), inguinal hernia repair (20% to 47%, p ≤ 0.001), appendectomy (38% to 93%, p ≤ 0.001), colectomy (8% to 43%, p ≤ 0.001), gastrectomy (43% to 84%, p = 0.048), and Nissen (71% to 91%, p = 0.21). Conclusion: While the overall operative volume has increased nationally for surgical residents, the representation of open cases has steadily declined since the advent of MIS. The experience needed in open surgery during resident training is still to be determined and may be necessary now that laparoscopy is progressively replacing open operations.
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Affiliation(s)
- Ace St John
- University of Maryland Medical Center, Baltimore, Maryland
| | | | | | - Stephen M Kavic
- University of Maryland School of Medicine, Baltimore, Maryland
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Kearse LE, Zeineddin A, Schmiederer IS, Korndorffer JR, Lau JN. A 20-year review of surgical training case logs: Is general surgery still general? Surgery 2021; 170:1347-1352. [PMID: 33975730 DOI: 10.1016/j.surg.2021.03.062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/12/2021] [Accepted: 03/31/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Surgical training has undergone many facets of restructuring over the most recent decades, with critiques of the quality and variability of training as well as the competency of recent graduates. This study examines the changes in surgical training in operative volume and breadth in the past 2 decades. METHODS The Accreditation Council for Graduate Medical Education Case Log Statistics Reports from 1999 to 2019 were reviewed. Case logs were grouped into defined case categories and group levels of postgraduate training. Descriptive analyses and multiple linear regressions were performed. RESULTS General surgery residents are graduating with 10.7% more cases, owing to increases in mostly junior year cases (P < .001). The breadth of specialty cases has decreased, while there was an increase in alimentary and abdominal cases to 58.4% from 47.2% 20 years ago. A decrease in vascular surgery cases from 19.9% to 10.7% of all cases was noted. Analysis of the distribution of defined categories showed right skewness in many categories with mode being much lower than reported mean. CONCLUSION Evaluation of trends, despite residents graduating with higher case volume than the minimum required, shows that the breadth and variety of cases has narrowed significantly in the past 20 years, providing a case for general surgery training restructuring.
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Affiliation(s)
- LaDonna E Kearse
- Department of Surgery, Stanford University School of Medicine, Stanford, CA.
| | - Ahmad Zeineddin
- Department of Surgery, Howard University Hospital, Washington, DC
| | | | | | - James N Lau
- Department of Surgery, Loyola University Medical Center, Maywood, IL
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Smith BK, Sheahan MG, Sgroi M, Weis T, Singh N, Rigberg D, Coleman DM, Lee JT, Shames ML, Mitchell EL. Addressing Contemporary Management of Vascular Trauma: Optimization of Patient Care Through Collaboration. Ann Surg 2021; 273:e171-e172. [PMID: 33824252 DOI: 10.1097/sla.0000000000004861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Brigitte K Smith
- Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Malachi G Sheahan
- Division of Vascular and Endovascular Surgery, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Michael Sgroi
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stanford University, Palo Alto, CA
| | - Tahlia Weis
- Vascular Surgery at Marshfield Clinic Health System, Marshfield, WI
| | - Niten Singh
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Washington, Seattle, WA
| | - David Rigberg
- Division of Vascular Surgery, Department of Surgery, University of California - Los Angeles, Los Angeles, CA
| | - Dawn M Coleman
- Division of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Jason T Lee
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stanford University, Palo Alto, CA
| | - Murray L Shames
- Division of Vascular Surgery, Department of Surgery, University of South Florida, Tampa, FL
| | - Erica L Mitchell
- Academic Sabbatical, Masters in Healthcare Delivery Science, Dartmouth, Hanover, NH
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Identifying technical skills and clinical procedures in surgery for a simulation-based curriculum: a national general needs assessment. Surg Endosc 2021; 36:47-56. [PMID: 33398569 DOI: 10.1007/s00464-020-08235-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The efficacy of simulation-based training in surgical education is well known. However, the development of training programs should start with problem identification and a general needs assessment to ensure that the content is aligned with current surgical trainee needs. The objective of the present study is to identify the technical skills and clinical procedures that should be included in a simulation-based curriculum in general surgery. METHODS A national, three-round Delphi process was conducted to achieve consensus on which technical skills and clinical procedures should be included in a simulation-based curriculum in general surgery. In total, 87 key opinion leaders were identified and invited to the study. RESULTS Round 1 of the Delphi process had a response rate of 64% (56/87) and a total of 245 suggestions. Based on these suggestions, a consolidated list of 51 technical skills or clinical procedures was made. The response rate in Delphi round 2 was 62% (54/87) resulting in a pre-prioritized order of procedures for round 3. The response rate in Delphi round 3 was 65% (35/54). The final list included 13 technical skills and clinical procedures. Training was predominantly requested within general open surgical skills, laparoscopic skills, and endoscopic skills, and a few specific procedures such as appendectomy and cholecystectomy were included in the final prioritized list. CONCLUSION Based on the Delphi process 13 technical skills and clinical procedures were included in the final prioritized list, which can serve as a point of departure when developing simulation-based training in surgery.
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White MD, Agarwal N, Alan N. Longitudinal Survey of Trainee Case Log Entry for Carotid Endarterectomy: Trends in Neurologic, General, and Vascular Surgery. World Neurosurg 2020; 146:e658-e663. [PMID: 33144210 DOI: 10.1016/j.wneu.2020.10.145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Multiple surgical specialties perform carotid endarterectomy (CEA). As indications for CEA narrows, neurosurgery residents are less exposed to this procedure. This study aims to determine trends in CEA training among graduating trainees in neurosurgery and compare these to general and vascular surgery. METHODS ACGME case log reports were retrospectively reviewed from 2013 to 2019 for neurologic, general, and vascular surgery residencies and vascular surgery fellowship. These annual reports contain the mean number of logged cases for graduating trainees and their level of participation. We analyzed trends in logged cases over the study period and compared mean number of logged cases between specialties and their respective required minimum numbers. RESULTS Neurosurgery residents (13.5 ± 0.76) performed significantly more CEAs than their counterparts in general surgery (9.4 ± 0.34, P < 0.01) but less in integrated vascular surgery (57.7 ± 0.88) and vascular surgery fellowship (47.9 ± 0.79, both P < 0.001). The only statistically significant change over the study period was a decline in mean number of cases logged by general surgery residents at -0.4 cases/year (P < 0.001). Trainees in all specialties reported around twice as many cases as the respective Accreditation Council for Graduate Medical Education required minimum numbers. Neurosurgery residents demonstrated increasing participation as lead surgeons by 0.7 cases/year (P = 0.04) and a concurrent decline as senior surgeons by 1.4 cases/year (P < 0.01). CONCLUSIONS Neurosurgery residents exceeded their minimum requirements for CEA, with increasing trend in higher level of participation. But neurosurgery residents' exposure to this procedure was far less significant than their colleagues in vascular surgery, a gap that may widen over time and should be addressed proactively.
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Affiliation(s)
- Michael D White
- Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Nima Alan
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
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Resident experience in brachytherapy: An analysis of Accreditation Council for Graduate Medical Education case logs for intracavitary and interstitial brachytherapy from 2007 to 2018. Brachytherapy 2020; 19:718-724. [DOI: 10.1016/j.brachy.2019.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/20/2019] [Accepted: 10/23/2019] [Indexed: 11/18/2022]
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Talutis SD, de Geus SWL, Farber A, Levin SR, Cheng TW, Sachs TE, Tseng JF, Siracuse JJ. Contemporary Analysis of Senior Level Case Volume Variation between Traditional Vascular Surgery Fellows and Integrated Vascular Surgery Chief Residents. Ann Vasc Surg 2020; 70:245-251. [PMID: 32645356 DOI: 10.1016/j.avsg.2020.06.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/25/2020] [Accepted: 06/25/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The present study compares the senior level operative experience of graduates from the traditional vascular surgery fellowship (5 + 2) and integrated vascular surgery training programs (0 + 5) using contemporary operative case log data. METHODS The Accreditation Council for Graduate Medical Education integrated vascular surgery, vascular surgery fellowship, and general surgery case logs for trainees graduating between 2013 and 2018 were queried for vascular surgery procedures. "Senior" cases were categorized as cases logged as "surgeon fellow" by 5 + 2 trainees or "surgeon chief" (post graduate year-4,5) by 0 + 5 trainees. Overall case volume was defined as the combined volume of cases logged as "surgeon junior," "surgeon chief," "surgeon fellow," "teach assist," "first assist," or "secondary procedure." To reflect total vascular experience, all vascular cases done during general surgery residency were combined with cases performed during vascular surgery fellowship. Mean case volumes were compared for all operations/procedures. RESULTS The 5 + 2 trainees had higher mean volume of open repair of suprarenal aortic aneurysms (2.4 vs. 1.4, P = 0.0026) and open repair of thoracic aortic aneurysms (0.5 vs. 0.3, P = 0.004) at the fellow level compared to 0 + 5 surgeon chief cases. Additionally, 5 + 2 trainees performed more endovascular repair of abdominal aortoiliac aneurysm (44.7 vs. 28.4, P < 0.0001), endovascular repair of iliac artery aneurysm (1.9 vs. 1.2, P = 0.0003), and endovascular repair of thoracic aortic aneurysm (14.9 vs. 8.4, P < 0.0001). The 5 + 2 fellows performed more vein bypasses than 0 + 5 chief residents (femoral-popliteal 9.8 vs. 6.4, P = 0.002; infrapopliteal 13.9 vs. 8.8, P = 0.0490), extra-anatomic bypasses (axillofemoral 4.2 vs. 2.9, P = 0.0004; femoral-femoral 5.6 vs. 3.1, P = 0.034), carotid endarterectomies (47.3 vs. 29.3, P < 0.0001), carotid artery stenting (9.6 vs. 4.5, P = 0.0001), celiac/SMA endarterectomy or bypass (3.7 vs. 1.9, P < 0.0001), renal artery balloon angioplasty/stenting (5.0 vs. 2.5, P = 0.0006), thoracic outlet decompression (5.4 vs. 1.9, P < 0.0001), traumatic repairs [thoracic vessels (0.5 vs. 0.1, P < 0.0001), neck vessels (0.7 vs. 0.3, P = 0.0004), abdominal vessels (3.0 vs. 1.7, P = 0.0005), and peripheral vessels (6.6 vs. 3.1, P = 0.034)], as well as a higher mean volume of arteriovenous (AV) fistulas (30.7 vs. 15.7, P < 0.0001), AV grafts (10.7 vs. 5.1, P < 0.0001), and revision of AV access (16.1 vs. 8.0, P = 0.0003). CONCLUSIONS Although both pathways graduate trainees with a similar overall surgical experience, 5 + 2 trainees log significantly more "Senior" cases. Further studies investigating potential variation in operative autonomy between both pathways are necessary.
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Affiliation(s)
- Stephanie D Talutis
- Department of Surgery, Boston Medical Center, Boston University, School of Medicine, Boston, MA
| | - Susanna W L de Geus
- Department of Surgery, Boston Medical Center, Boston University, School of Medicine, Boston, MA
| | - Alik Farber
- Department of Surgery, Boston Medical Center, Boston University, School of Medicine, Boston, MA
| | - Scott R Levin
- Department of Surgery, Boston Medical Center, Boston University, School of Medicine, Boston, MA
| | - Thomas W Cheng
- Department of Surgery, Boston Medical Center, Boston University, School of Medicine, Boston, MA
| | - Teviah E Sachs
- Department of Surgery, Boston Medical Center, Boston University, School of Medicine, Boston, MA
| | - Jennifer F Tseng
- Department of Surgery, Boston Medical Center, Boston University, School of Medicine, Boston, MA
| | - Jeffrey J Siracuse
- Department of Surgery, Boston Medical Center, Boston University, School of Medicine, Boston, MA.
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Parihar S, Benarroch-Gampel J, Teodorescu V, Ramos C, Minton K, Rajani RR. Vascular Surgeons Carry an Increasing Responsibility in the Management of Lower Extremity Vascular Trauma. Ann Vasc Surg 2020; 70:87-94. [PMID: 32422294 DOI: 10.1016/j.avsg.2020.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 04/21/2020] [Accepted: 05/02/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND There is preliminary evidence that vascular surgeons are increasingly relied on nationally to assist with the management of lower extremity vascular trauma. Current trauma center verification, however, does not require any level of vascular surgery coverage. We sought to assess practice patterns regarding vascular surgery consultation and temporal trends in the surgical management of these patients. METHODS A retrospective analysis was performed on all patients who underwent surgical repair for vascular trauma of the lower extremity at a single, academic, public hospital from 2011 to 2018. Demographic data and procedural data were collected. Patients were assigned to a vascular surgery (VS) or nonvascular surgery (NV) group. The primary outcome measure was the rate of VS consultation. Secondary outcome measures included 30-day mortality, length-of-stay, and limb salvage. RESULTS One hundred eighty patients were identified (77 VS group, 103 NV group). There was an increase in the proportion of repairs done by VS from 2011 to 2018 (P < 0.05). There were significant management differences between the 2 groups, with vascular surgeons more likely to perform primary end-to-end anastomosis for both arterial (21.33% vs. 6.90%) and venous (19.15% vs. 5.26%) injuries (both P < 0.05). Patients in the VS group were less likely to have balloon embolectomy, fasciotomy, or intravascular shunting than the NV group (all P < 0.05). There were no significant differences in mortality (5.35% vs. 4.85%), length-of-stay (15.05 vs. 18.38 days), or limb salvage (94.81% vs. 95.15%). CONCLUSIONS Lower extremity vascular trauma is increasingly managed by vascular surgeons. Furthermore, vascular surgeons are more selective in the use of potentially unnecessary adjunctive maneuvers. Current accreditation guidelines should be revisited to mandate vascular surgery coverage in trauma centers that frequently treat this patient population.
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Affiliation(s)
- Sid Parihar
- Division of Vascular and Endovascular Surgery, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA
| | - Jaime Benarroch-Gampel
- Division of Vascular and Endovascular Surgery, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA
| | - Victoria Teodorescu
- Division of Vascular and Endovascular Surgery, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA
| | - Christopher Ramos
- Division of Vascular and Endovascular Surgery, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA
| | - Keri Minton
- Division of Vascular and Endovascular Surgery, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA
| | - Ravi R Rajani
- Division of Vascular and Endovascular Surgery, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA.
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Gas off, room lights on: Shedding light on the surgical resident’s experience in open and laparoscopic surgery. Surgery 2019; 166:460-468. [DOI: 10.1016/j.surg.2019.04.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/23/2019] [Accepted: 04/25/2019] [Indexed: 11/18/2022]
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Saadeddin ZM, Rybin DV, Doros G, Siracuse JJ, Farber A, Eslami MH. Comparison of Early and Late Post-operative Outcomes after Supra-inguinal Bypass for Aortoiliac Occlusive Disease. Eur J Vasc Endovasc Surg 2019; 58:529-537. [DOI: 10.1016/j.ejvs.2019.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 02/12/2019] [Indexed: 10/26/2022]
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Shirasu T, Furuya T, Nagai M, Nomura Y. Learning Curve Analysis to Determine Operative Requirements for Young Vascular Surgeons Learning Open Abdominal Aortic Aneurysm Repair. Circ J 2019; 83:1868-1875. [PMID: 31353341 DOI: 10.1253/circj.cj-19-0386] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Since endovascular aneurysm repair has become predominant, the issue of training young vascular surgeons in open abdominal aortic aneurysm (AAA) surgery has received significant attention. Through learning curve analysis, we aimed to determine the number of cases needed for young surgeons to achieve satisfactory open surgical skills.Methods and Results:A total of 562 consecutive patients who underwent open repair either by an attending surgeon (group A) or 6 young vascular surgeons (group Y) were included and assessed with regards to the preparation, clamp, and total operation times. Although some of the patients' characteristics were different, the surgical procedures were comparable between the 2 groups. There was a clear trend towards a decrease in each 10 successive cases in group Y. The operation times in group A were constant at 72±30 (preparation), 48±10 (clamp), and 231±59 min (total), which were achieved by young vascular surgeons in 10, 30, and 10 cases, respectively. In the cumulative sum analysis, 25-27 cases were necessary for young vascular surgeons to enhance their surgical skills. The complication rate in group Y was no higher than that in group A. CONCLUSIONS Young vascular surgeons can safely learn open AAA repair without increasing operation time or complications. Approximately 30 cases would be necessary to gain satisfactory surgical skills.
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Affiliation(s)
- Takuro Shirasu
- Department of Surgery, Asahi General Hospital.,Division of Vascular Surgery, Department of Surgery, The University of Tokyo
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Shannon AH, Robinson WP, Hanks JB, Potts JR. Impact of New Vascular Fellowship Programs on Vascular Surgery Operative Volume of Residents in Associated General Surgery Programs. J Am Coll Surg 2019; 228:525-532. [DOI: 10.1016/j.jamcollsurg.2018.12.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 12/20/2018] [Indexed: 10/27/2022]
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Bax T, Moore EE, Macalino J, Moore FA, Martin M, Mayberry J. Eraritjaritjaka revisited: The future of trauma and acute care surgery a symposium of the 2018 North Pacific Surgical Association Annual Meeting. Am J Surg 2019; 217:821-829. [PMID: 30606450 DOI: 10.1016/j.amjsurg.2018.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 12/16/2018] [Accepted: 12/17/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Timothy Bax
- Trauma Program Medical Director, Providence Sacred Heart Medical Center, Spokane, WA, USA
| | - Ernest E Moore
- University of Colorado Department of Surgery & Ernest E Moore Shock Trauma Center at Denver Health, Denver, CO, USA
| | - Joel Macalino
- Chairman, Philippine College of Surgeons Committee on Trauma, University of the Philippines College of Medicine, De La Salle University College of Medicine, San Beda University College of Law, & Ateneo de Zamboanga School of Law, Manila, Philippines
| | - Frederick A Moore
- Chief of Acute Care Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Matthew Martin
- Trauma Program Medical Director, Madigan Army Medical Center, Joint Base Lewis-McChord, WA, USA
| | - John Mayberry
- St Lukes Wood River Medical Center, Ketchum, ID, USA.
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