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Residency Training and Hand Surgery Practice Patterns: A National Surgical Quality Improvement Program Database

James J Drinane¹, Brian Drolet², Ashit Patel¹

¹Department of Surgery, The Division of Plastic Surgery, Albany Medical Center, Albany, New York, United States.

Journal of Hand and Microsurgery

|August 19, 2022

Summary

Residency background significantly impacts hand surgery practice patterns, with orthopedic surgeons leading in bone and tendon procedures, while plastic and general surgeons excel in soft tissue cases. Fellowship training does not fully standardize surgical practice.

Keywords:

National Surgical Quality Improvement Program hand surgery fellowship practice patterns residency training

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Area of Science:

Orthopedic Surgery
Plastic Surgery
General Surgery
Hand Surgery

Background:

Fellowship-trained hand surgeons originate from diverse residency backgrounds, including orthopedic, plastic, and general surgery.
This variability in training may lead to differences in surgical practice patterns and case focus.

Purpose of the Study:

To investigate the impact of different residency training backgrounds on the practice patterns of fellowship-trained hand surgeons.
To analyze hand surgery volumes and case variety based on surgical specialty using national database data.

Main Methods:

Utilized the National Surgical Quality Improvement Database (NSQIP) from 2008 to 2017.
Queried Current Procedural Terminology (CPT) codes for hand surgery procedures, categorized by type and specialty.
Compared procedural volumes against hand society membership data to assess distribution alignment.

Main Results:

A total of 145,015 hand surgeries were analyzed.
Orthopedic surgeons performed the majority of cases (71.3%), with a focus on bone, fracture, joint, and tendon procedures.
Plastic surgeons (19.6%) and general surgeons (9.1%) performed a higher-than-expected volume of soft tissue coverage cases.

Conclusions:

Hand surgery fellowship training is accessible from multiple surgical residency pathways.
Residency training background significantly influences the types of hand surgery procedures performed in practice.
Fellowship training does not fully homogenize practice patterns, highlighting the lasting impact of initial surgical education.