Open appendectomy: no longer an intern case

Laparoscopy and work-hour restrictions are altering surgical training. We hypothesized interns were no longer gaining experience in open appendectomy, historically an intern index case. We retrospectively reviewed Accreditation Council for Graduate Medical Education (ACGME) case logs of postgraduate Year (PGY) 1 general surgery trainees from our academic teaching program for the last 9 years. Number of appendectomies performed (Current Procedural Terminology codes 44950, 44960, and 44970) were recorded and analyzed. The national ACGME database was similarly evaluated for resident experience during junior (PGY-1 to 4) years. Data were available for 47 residents completing internship at our institution between 2003 and 2011. Mean number of appendectomies performed per intern steadily decreased throughout the study period from 22 in 2003 to 5 in 2011 (P=0.0367). Mean percentage of cases done open decreased from 79.5 to 2.4 per cent (P=0.0001). National data found residents graduating in the year 2000 performed an average of 26.6 open appendectomies during junior years, whereas those graduating in 2011 had done only 13.7. Surgical trainees are performing fewer open appendectomies than just several years ago. Open appendectomy traditionally served as an introduction to open surgery. Because outcome differences are small between open and laparoscopic appendectomy, we propose teaching institutions consider performing open appendectomies in select patients to preserve an important educational experience.