Vascular Trauma Operative Experience is Inadequate in General Surgery Programs

Area of Science:

• Surgical Education
• Trauma Surgery
• Vascular Surgery

Background:

• Vascular injuries present significant challenges for surgeons lacking specialized fellowship training.
• Inadequate experience and improper techniques can lead to severe complications in managing vascular trauma.
• Assessing trends in resident operative experience with vascular trauma is crucial for improving surgical training.

Purpose of the Study:

• To analyze changes in the number of operative vascular trauma cases performed by general surgery residents over a decade.
• To compare resident experience between two academic institutions affiliated with Level 1 trauma centers.

Main Methods:

• Retrospective review of Accreditation Council for Graduate Medical Education (ACGME) case logs.
• Analysis of general surgery residents graduating between 2004 and 2014 from two university-affiliated Level 1 trauma centers.
• Primary outcome: number of reported vascular trauma operations, stratified by graduation year and institution.

Main Results:

• A median of 7 vascular trauma cases per resident were reported.
• Fasciotomy and peripheral vessel repair comprised the majority of procedures.
• No significant trend in vascular trauma cases was observed with respect to the year of graduation (P=0.266).
• Program A residents (n=53) reported significantly more cases (12.0) than Program B residents (n=59) (5.0 cases, P<0.001).

Conclusions:

• Level 1 trauma center verification does not ensure adequate resident exposure to vascular trauma.
• Program B's operative exposure aligns with the national ACGME average (4.0 cases/resident), indicating a persistent trend.
• Vascular surgery fellowship training is essential for surgeons in trauma settings, particularly in underserved areas.