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Assessment of the Operative Vascular Surgical Experience of General Surgery Residents
*Brianna M Krafcik, *Teviah Sachs, *Denis Rybin, *Gheorghe Doros, Alik Farber, *Jeffrey Kalish, *Mohammad H Eslami, *Jeffrey Siracuse
Boston Medical Center, Boston, MA

Objectives
General surgeons, particularly in rural settings, have traditionally performed open vascular surgeries. However, endovascular surgery, vascular residencies, and work-hour limitations may have impacted vascular training among general surgery residents. We evaluated the temporal trend of open vascular surgical procedures by general surgery residents.
Methods
The Accreditation Council for Graduate Medical Education (ACGME) database was used to evaluate case volume of graduating chief residents from 1999-2013. Mean reported (±SD) case volumes were analyzed for carotid endarterectomy (CEA), open infrarenal aorto/iliac aneurysm repair and infrainguinal bypass. Temporal trends were compared using R2.
Results
Average CEAs for general surgery residents decreased from 23.1 ± 14 (11.6 ± 9 chief, 11.4 + 10 junior) cases per resident in 1999 to 10.7±9 (3.4 ± 5 chief, 7.3 ± 6 junior) in 2012 (R2=0.98). Similarly, open elective aorto/iliac aneurysms repair decreased from 7.4 ± 5 (4 ± 4 chief, 3.4 ± 4 junior) in 1999 to 1.3 ± 2 (0.4 ± 1 chief, 0.8 ± 1 junior) in 2012 (R2=0.98). Femoral-popliteal bypasses from 2001-2012 decreased from 8.6 ± 4 (3.5 ± 2 chief, 5.2 ± 3 junior) to 4.6 ± 3 (1.4 ± 1 chief, 3.2 + 2 junior) (R2=0.97). In particular, femoral-tibial bypasses decreased from 8.1 ± 3.8 (3.5 ± 2.2 chief, 4.5 ± 2.9 junior) to 3.0 ± 2.2 (1 ± 1.6 chief, 2 ± 1.6 junior) (R2=0.91). These decreases were gradual.
Conclusion
Exposure of general surgery residents to open vascular surgery procedures has significantly and steadily decreased. Current graduates of general surgery residencies are unlikely to have adequate experience with these operations to be safely credentialed to perform them in future practice without advanced vascular surgery training.


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