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National Trends in Trainee Operative Exposure to Upper Extremity Fasciotomy Support a Multidisciplinary Approach
Christina L Cui1, Crystal Jing2, Daemar Jones1
1Department of Surgery, Division of Vascular and Endovascular Surgery, Duke University Medical Center, Durham, NC.
Background:
Acute limb ischemia of the upper extremity is an uncommon but emergent clinical scenario, in which both revascularization and decompressive fasciotomy may be indicated to optimize patient outcomes. The purpose of this study was to examine operative exposure to upper extremity fasciotomy among surgical trainees across different specialties.
Methods:
Accreditation Council for Graduate Medical Education national data reports were reviewed for operative volumes as reported by vascular surgery integrated residents (VSRs), vascular surgery fellows (VSFs), orthopedic surgery residents (OSRs), and hand surgery fellows (HSFs). Data were analyzed via univariate tests and linear regression analysis for trends.
Results:
From 2013 to 2022, HSF graduates performed a mean of 51.7 ± 6.4 upper extremity fasciotomy procedures, and OSR graduates performed 6.0 ± 0.7 fasciotomy procedures (P < 0.0001 versus HSF). Over the same time period, both VSF and VSR reported zero upper extremity fasciotomy procedures performed at time of graduation (P < 0.0001 each versus HSF). OSR graduates also reported 42.7 ± 7.9 carpal tunnel release procedures, with an annual increase of 2.5 ± 0.3 cases on linear regression analysis (R2 = 0.89, P < 0.0001). Neither OSR (annual trend, 0.1 ± 0.1 cases/year, R2 = 0.18, P = 0.18) nor HSF groups (annual trend, 0.0 ± 0.1 cases/year, R2 = 0.01, P = 0.83) experienced a decline in upper extremity fasciotomy operations performed over the 10-year study period. Revascularization procedures were performed by VSR (4.3 ± 0.7 cases), VSF (3.5 ± 0.6 cases), and HSF (15.1 ± 1.2 cases) groups. Accreditation Council for Graduate Medical Education data reports did not report data on upper extremity revascularization procedures performed by OSR graduates.
Conclusion:
Vascular operations of the upper extremity remain an integral component of surgical training across multiple specialties; however, vascular surgical trainees have minimal operative exposure to upper extremity fasciotomy. These data underscore the importance of a multidisciplinary approach to patients presenting with acute limb ischemia of the upper extremity.
