title: Are open abdominal procedures a thing of the past? An analysis of graduating general surgery residents' case logs from 2000 to 2011.
abstract: BACKGROUND
  Since the introduction of laparoscopic surgery for cholecystectomy in 1989, the growth of minimally invasive surgery (MIS) has increased significantly in the United States. There is a growing concern that the pendulum has now shifted too far toward MIS and that current general surgery residents' exposure to open abdominal procedures is lacking.
  
  
  OBJECTIVE
  We sought to analyze trends in open vs MIS intra-abdominal procedures performed by residents graduating from US general surgery residency programs over the past twelve years.
  
  
  METHODS
  We conducted a retrospective analysis of the data from the ACGME national resident case log reports for graduating US general surgery residents from 2000 to 2011. We analyzed the average number of cases per graduating chief resident for the following surgical procedures: appendectomy, inguinal/femoral hernia repair, gastrostomy, colectomy, antireflux procedures, and cholecystectomy.
  
  
  RESULTS
  For all the procedures analyzed, except antireflux procedures, a statistically significant increase in the number of MIS cases was seen. The increases in MIS procedures were as follows: appendectomy, 8.5 to 46 (542%); inguinal/femoral hernia repair, 7.6 to 23.3 (265%); gastrostomy, 1.4 to 3 (114%); colectomy, 1.8 to 18.2 (1011%); and cholecystectomy, 84 to 105.7 (26%). The p value was set at <0.001 for all procedures. There has been a concomitant decrease in the number of open procedures. The numbers of open appendectomy decreased from 30.9 to 15.5 (p < 0.0001), open inguinal/femoral hernia repair from 52.1 to 48 (p = 0.0038), open gastrostomy from 7.7 to 4.9 (p = 0.0094), open colectomy from 48 to 40.7 (p < 0.0001), open cholecystectomy from 15.5 to 10.4 (p = 0.0005), and open antireflux procedures from 4.7 to 1.7 (p < 0.001). An analysis conducted over time reveals that the rates of increase in MIS procedures in 5 of the 6 categories continue to rise, whereas the rates of open appendectomy, open colectomy, and open antireflux procedures continue to decrease. However, the rates of decline of open hernia repairs and open gastrostomies seem to have plateaued.
  
  
  CONCLUSIONS
  The performance of open procedures in general surgery residency has declined significantly in the past 12 years. The effect of the decline in open cases in surgical training and practice remains to be determined.
authors.affiliation: Department of Surgery, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota. Electronic address: dr.andrew.mccoy@gmail.com.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: McCoy
authors.forename: Enej
authors.initials: E
authors.lastname: Gasevic
authors.forename: Randolph E
authors.initials: RE
authors.lastname: Szlabick
authors.forename: Abe E
authors.initials: AE
authors.lastname: Sahmoun
authors.forename: Robert P
authors.initials: RP
authors.lastname: Sticca
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000328:Adult; D002983:Clinical Competence; D003162:Competency-Based Education; D013505:Digestive System Surgical Procedures / Q000193:education / Q000379:methods*; D004503:Education, Medical, Graduate / Q000639:trends; D005260:Female; D013502:General Surgery / Q000193:education; D006801:Humans; D015994:Incidence; D007396:Internship and Residency / Q000639:trends; D010535:Laparoscopy / Q000193:education* / Q000706:statistics & numerical data; D007813:Laparotomy / Q000193:education* / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D061214:Patient Safety; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States
keywords: ACGME; Medical Knowledge; Patient Care; Systems-Based Practice; laparoscopic education; minimally invasive surgery; resident case log; resident education; surgical education