Single-center trends in open abdominal case volume in vascular surgery Accreditation Council for Graduate Medical Education trainees over time

Background There remains a role for open aortic surgery within the landscape of progressively evolving endovascular techniques in management of abdominal aortic disease. Graduates from vascular surgery training programs must be equipped to address open aortic surgery inclusive of aneurysmal, occlusive, mesenteric, venous, and mycotic processes. Programs are faced with the challenge of adequately preparing trainees in an environment where open aortic surgery cases are decreasing nationally. In addition to decreasing volume of open aortic surgery on a national level, the complexity of patients receiving open aortic surgery is increasing as endovascular techniques advance to handle more complex anatomy. As a result, open aortic surgery is being performed at a concentrated number of centers, further challenging many training programs. This is a retrospective review of graduate case logs at a single large academic institution between 2004 and 2023 aimed at investigating trends in trainee exposure to aortic surgery over time. Methods This is a single large academic institution retrospective review of Accreditation Council for Graduate Medical Education (ACGME) case logs for graduates of both the traditional (5 + 2) fellowship (2004-2023) and the integrated (0 + 5) residency (2015-2023). Primary endpoints include total cases, total open abdominal cases, total open aneurysm cases, and total endovascular abdominal aortic cases. Secondary analysis includes evaluation of endovascular case volume over time and analysis of graduate gender-based differences in case volume. Results A total of 30 trainees graduated from this institution between 2004 and 2023; 23 traditional fellows (5 + 2) and 7 integrated residents (0 + 5). On average, graduates performed 1325.2 ± 439 total cases during their training with no significant difference between fellowship and residency graduates. Total case volume did not change across time. On average, graduates performed 69.5 ± 17.5 open abdominal cases with no significant variation between fellowship and residency graduates ( P > .05). The number of open abdominal cases performed during training did not change across time. Open aortic aneurysm repairs (average, 27.2 ± 7.6) and open reconstruction of aortoiliac occlusive disease (average, 26.4 ± 10.3) were the most frequent cases within the open abdominal category. There was no variation across time or graduate type for cerebrovascular, peripheral obstructive, or endovascular categories ( P > .05). There was no variation in total case volume or open abdominal cases when compared across genders ( P > .05). Conclusions No variation in open abdominal cases performed by vascular surgery graduates was observed across time in this retrospective review of a single large academic institution. There appears to be a notable concentration of cases toward large academic centers resulting in stability in case volume at this institution. Results of this study can inform discussions regarding the utility of advanced aortic fellowships and assist future trainees with selecting programs that align with their clinical career goals. The ability to perform complex open and endovascular operations is a cornerstone of the vascular surgery specialty, and results of this study highlight that recently graduated trainees from this institution and similar institutions remain dynamic in their abilities and are prepared to address open abdominal surgery.