title: How can trauma surgeons maintain their operative skills?
abstract: BACKGROUND
  The operative experience of the dedicated trauma surgeon is declining. Much attention has focused on the operative workload of trauma surgeons as it is critical in both maintaining operative skills and promoting the interest of surgical residents in trauma careers. We examined the operative experience of our surgical service which includes trauma, emergency general surgery, and elective general surgery to analyze changes occurring over the past decade.
  
  
  METHODS
  A retrospective study was performed by extracting data from the operative database at our Level I trauma center from January 1995 to December 2005. The cases were classified as trauma, emergency general surgery, or elective general surgery. Data were analyzed using weighted linear regression to analyze statistical significance.
  
  
  RESULTS
  Although the total number of cases performed by the trauma service remained constant, the proportion of initial operative trauma cases (<24 hours from arrival to operation) decreased from 14% to 8% (r2 = 0.91, p < 0.001) over the study period. In contrast, emergency general surgery cases increased over this time period (r2 = 0.57, p < 0.01). Elective case volume was unchanged. The majority of the waning of trauma cases was due to decreased surgery on the liver and spleen and fewer neck explorations.
  
  
  CONCLUSIONS
  Trauma operative experience decreased but emergency general surgery increased over a decade at our trauma center. It appears possible to maintain a busy operative trauma service by the inclusion of emergency general surgery consultations.
authors.affiliation: Section of Trauma, Surgical Critical Care, and Surgical Emergencies, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA.
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Schuster
authors.forename: Peter P
authors.initials: PP
authors.lastname: Lopez
authors.forename: Tobi
authors.initials: T
authors.lastname: Greene
authors.forename: Kerry
authors.initials: K
authors.lastname: Wheeler
authors.forename: Dror
authors.initials: D
authors.lastname: Soffer
authors.forename: Fahim
authors.initials: F
authors.lastname: Habib
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Cohn
authors.forename: Carl I
authors.initials: CI
authors.lastname: Schulman
mesh_terms: D001062:Appendectomy / Q000706:statistics & numerical data; D002763:Cholecystectomy / Q000706:statistics & numerical data; D002983:Clinical Competence; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005431:Florida; D013502:General Surgery / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D012189:Retrospective Studies; D014194:Traumatology / Q000592:standards* / Q000706:statistics & numerical data; D016526:Workload / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000453:epidemiology