Concerning Trends in Acute Care Surgeries Among General Surgery Trainees

Surveys of residents, program directors, and fellowship leaders have raised concerns about general surgery graduates' readiness for independent practice. Evolving practice patterns, particularly the rise of laparoscopic surgery, advanced endoscopy, and interventional radiology, have altered residents' exposure to traditional open procedures. However, the impact of these changes on operative experience in acute care surgery (ACS) has not been well quantified.

This study assessed temporal trends in the operative experience of general surgery trainees in the acute care surgery component.

We analyzed publicly available ACGME operative case logs for graduating general surgery trainees from 2000 to 2023. Procedures categorized under acute care surgery were identified. Temporal trends were assessed using the Mann-Kendall trend test and visualized with line plots.

The average total case volume increased from 903 cases per trainee in 2006 to 1,062 in 2023. Despite the overall increase in case volume, exposure to multiple key ACS operations has declined to critically low levels. Notably, average case numbers per trainee for procedures such as splenectomy, duodenal perforation repair, open common bile duct exploration, choledochoenteric anastomosis, pancreatic abscess drainage, and esophageal perforation repair have fallen to fewer than 1 per trainee. The laparoscopic approach has largely supplanted the open approach across various procedures.

Although the total operative volume for general surgery trainees has increased over time, exposure to essential open ACS procedures has markedly declined. This trend raises concerns about the adequacy of operative experience in foundational emergency surgeries and may contribute to ongoing perceptions of insufficient preparedness among graduates.