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Resident Operative Experience in Hepatopancreatobiliary Surgery: Exposing the Divide

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

The Accreditation Council for Graduate Medical Education (ACGME) requires an experience in hepatopancreatobiliary (HPB) surgery as part of general surgery residency training. The composition of this experience, however, is unclear. We set out to evaluate current trends in the HPB experience of US general surgery residents.

Methods

National ACGME operative case logs from 1990 to 2016 were examined with a focus on the HPB operative domains. Time-trend analysis was performed using ANOVA and linear regression analysis.

Results

Median biliary, liver, and pancreatic operative volumes increased by 30%, 33%, and 27% over the 27-year study period (all p < 0.05). Both core and advanced HPB cases increased, but the rate of increase for core was four times greater than that of advanced. However, when cholecystectomy was excluded, this trend reversed such that HPB core operations decreased by 11 cases over the study period. Further analysis demonstrated that laparoscopic cholecystectomy comprised 90% of all biliary cases and 77% of all HPB cases for graduates in 2016. Finally, operative volume variability—the difference in case numbers between high and low volume residents—increased by 16%, 21%, and 73% for the biliary, liver, and pancreatic domains, respectively (all p < 0.05).

Conclusions

Despite increases in overall HPB operative volume, the HPB experience is changing for today’s surgical trainees. Moreover, the HPB experience is comprised largely of a single operation—the cholecystectomy. Awareness of these trends is important for surgical educators to facilitate adequate exposure to HPB surgery among general surgery residents.

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Authors and Affiliations

  1. Cincinnati Research on Education in Surgical Training (CREST), Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, ML 0558, Cincinnati, OH, 45267-0558, USA

    Alexander R. Cortez, Leah K. Winer, Al-Faraaz Kassam & R. Cutler Quillin III

  2. Department of Surgery, University of Louisville, Louisville, KY, USA

    Gianna D. Katsaros

  3. Division of Transplantation, Department of Surgery, University of Cincinnati, Cincinnati, OH, USA

    Shimul A. Shah, Tayyab S. Diwan & R. Cutler Quillin III

Authors
  1. Alexander R. Cortez
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  2. Leah K. Winer
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  3. Gianna D. Katsaros
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  4. Al-Faraaz Kassam
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  5. Shimul A. Shah
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  6. Tayyab S. Diwan
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  7. R. Cutler Quillin III
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Contributions

ARC and RCQ contributed significantly with study design, data collection, data analysis, interpretation of results, and drafting of manuscript; LKW and AK contributed to data analysis, interpretation of results, and drafting and editing of manuscript; GDK contributed to study design and data collection; TSD and SAS were involved with interpretation of results and critical revision of manuscript.

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Correspondence to Alexander R. Cortez.

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Cortez, A.R., Winer, L.K., Katsaros, G.D. et al. Resident Operative Experience in Hepatopancreatobiliary Surgery: Exposing the Divide. J Gastrointest Surg 24, 796–803 (2020). https://doi.org/10.1007/s11605-019-04226-9

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  • DOI: https://doi.org/10.1007/s11605-019-04226-9

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