Twenty-year analysis of surgical resident operative trauma experiences

The Accreditation Council for Graduate Medical Education (ACGME) implemented new work-hour rules for all U.S. residency programs beginning on July 1, 2003. The ACGME-mandated work-hour reform may have affected operative trauma case volumes of general surgery residents.

Using ACGME aggregate data collected from general surgery residency programs from 1990 to 2010, we examined the effect of the 2003 work-hour reform on resident operative trauma case volumes.

Overall trauma cases per year declined from 78.28 in 1990 to 38.73 in 2010. From 1990 to 2003, laparotomy, burn, and upper-gastrointestinal trauma cases fell at least 50%, from 9.97 to 4.85 cases/resident by 0.46 cases/y (95% confidence interval [CI], 0.456-0.459), 10.05 to 3.30 cases/resident by 0.61 cases/y (95% CI, 0.609-0.617), and 3.34 to 1.01 cases/resident by 0.189 cases/y (95% CI, 0.188-0.189), respectively. After 2003, laparotomy and burn cases began to rise by 0.23 cases/y (95% CI, 0.228-0.231) and 0.36 cases/y (95% CI, 0.358-0.368). Vascular trauma cases continued to decline from 8.63 cases/resident by 0.197 (95% CI, 0.196-0.198) pre-reform, but by 0.102 (95% CI, 0.099-0.105) post-reform. Junior surgical residents were increasingly involved in trauma operative cases from 67% in 1990 to 79% in 2010. Cardiac, pancreatic, genitourinary, and neurosurgical cases did not peak more than 1.95 cases/resident pre-reform.

Secular trends before the 2003 work-hour reform caused a 50% decrease in operative trauma experience among general surgery residents. Since 1990, junior residents have increasingly performed operative trauma. Rare trauma subspecialty cases remain rare. Post work-hour reform, operative trauma volumes have stabilized.