Current Trends in Surgical Procedures Performed in Rural General Surgery Practice

Background The procedures that rural general surgeons perform may be changing. It is important to recognize the trends and practices of the current rural general surgeon in efforts to better prepare general surgeons who desire to enter a practice in a rural environment. The aim of this review is to detail the recent operative case volumes of 6 rural locations in the upper Midwest where general surgery is practiced. Methods The Enterprise Data and Analytics department of Sanford Health compiled all surgical procedures performed within the Sanford Health System between January 1, 2013 and August 31, 2018. Procedures performed by a total of 58 general surgeons in locations of under 50 000 people are included in this review. Results From January 1, 2013 to August 31, 2018, 38 958 surgical procedures were performed in rural locations. Endoscopic procedures made up 61.6% of a rural general surgeon’s practice. Cholecystectomy (6.3%), hernia repair (6.3%), and appendectomy (3.7%) were the principle nonendoscopic procedures performed by rural surgeons, comprising 16.3% of the case volume. Added together, endoscopy, cholecystectomy, hernia repair, and appendectomy made up 77.9% of the rural general surgeon’s caseload. Vascular procedures (2.5%), breast procedures (1.8%), obstetrics (0.4%), and urology procedures (0.2%) are also included in this review. Conclusions Rural general surgeons are vital to the surgical workforce in the United States. Recognizing a trend that rural general surgeons perform less subspecialty procedures and more endoscopic procedures will provide direction for those interested in pursuing a career in rural general surgery.

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Article Commentary: Surgical Workforce in the American South

The American Surgeon ◽

10.1177/000313481107700208 ◽

2011 ◽

Vol 77 (2) ◽

pp. 133-138 ◽

Cited By ~ 1

Author(s):

Anthony Charles ◽

Katie Gaul ◽

Stephanie Poley

Keyword(s):

United States ◽

General Surgery ◽

Healthcare Access ◽

Surgical Care ◽

Population Expansion ◽

The United States ◽

General Surgeon ◽

Successful Implementation ◽

Surgical Access ◽

Surgical Workforce

There exists a geographic maldistribution of surgeons with significant regional characteristics, which is associated with surgical access differentials that may be contributing to existing health disparities in the United States. We sought to evaluate the trends in the surgical workforce in southern states of the United States from 1981 to 2006 using the American Medical Association Masterfile data. Our study revealed that the general surgery workforce growth peaked in 1986 and has had negative growth per capita as a result of the consistent population growth, unlike other regions in the country. Furthermore, the change in the geographic distribution of general surgeons in the South was slightly greater than for surgical specialists between 1981 and 2006. Twenty-nine per cent of all southern counties with a collective population of 7.4 million people had no general surgeon in 2006. The failure of the general surgery workforce to grow with population expansion has resulted in a significant number of counties that do not meet the recommended standards of geographic access to surgical care. An adequate solution to surgical workforce demand is imperative for viable and successful implementation of healthcare reform, particularly in geographic regions with large healthcare access disparities.

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General Surgery at Rural Tennessee Hospitals: A Survey of Rural Tennessee Hospital Administrators

The American Surgeon ◽

10.1177/000313481107700713 ◽

2011 ◽

Vol 77 (7) ◽

pp. 820-825

Author(s):

Joseph B. Cofer ◽

Tommy J. Petros ◽

Hans C. Burkholder ◽

P. Chris Clarke

Keyword(s):

Rural Communities ◽

National Survey ◽

General Surgery ◽

Response Rate ◽

General Surgeon ◽

Hospital Administrators ◽

Surgical Services ◽

Surgical Workforce ◽

General Surgeons ◽

The Mean

Rural communities face an impending surgical workforce crisis. The purpose of this study is to describe perceptions of rural Tennessee hospital administrators regarding the importance of surgical services to their hospitals. In collaboration with the Tennessee Hospital Association, we developed and administered a 13-item survey based on a recently published national survey to 80 rural Tennessee hospitals in August 2008. A total of 29 responses were received for an overall 36.3 per cent response rate. Over 44 per cent of rural surgeons were older than 50 years of age, and 27.6 per cent of hospitals reported they would lose at least one surgeon in the next 2 years. The responding hospitals reported losing 10.4 per cent of their surgical workforce in the preceding 2 years. Over 53 per cent were actively recruiting a general surgeon with an average time to recruit a surgeon of 11.8 months. Ninety-seven per cent stated that having a surgical program was very important to their financial viability with the mean and median reported revenue generated by a single general surgeon being $1.8 million and $1.4 million, respectively. Almost 11 per cent of the hospitals stated they would have to close if they lost surgical services. Although rural Tennessee hospitals face similar difficulties to national rural hospitals with regard to retaining and hiring surgeons, slightly more Tennessee hospitals (54 vs 36%) were actively attempting to recruit a general surgeon. The shortage of general surgeons is a threat to the accessibility of comprehensive hospital-based care for rural Tennesseans.

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Article Commentary: Cancer Immunotherapy for the General Surgeon

The American Surgeon ◽

10.1177/000313482008600423 ◽

2020 ◽

Vol 86 (4) ◽

pp. 284-292

Author(s):

Marc W. Fromer ◽

Charles R. Scoggins

Keyword(s):

United States ◽

Cancer Immunotherapy ◽

General Surgery ◽

Cancer Care ◽

The United States ◽

General Surgeon ◽

General Surgeons

Progress in the arena of cancer immunotherapy has been immense in recent years. The fact remains that most of the cancer resections in the United States are performed by general surgeons and not oncologic specialists. A busy practice in general surgery will invariably make it difficult to keep pace with such rapid advancement. This review offers a concise summary of the major concepts and trials that have driven the immunotherapy revolution and their implications for surgeons who deliver cancer care.

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Are general surgeons behind the curve when it comes to disaster preparedness training? A survey of general surgery and emergency medicine trainees in the United States by the Eastern Association for the Surgery for Trauma Committee on Disaster Preparedness

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0b013e318265c9d9 ◽

2012 ◽

Vol 73 (3) ◽

pp. 612-617 ◽

Cited By ~ 9

Author(s):

Andrew J. Dennis ◽

Mary-Margaret Brandt ◽

Justin Steinberg ◽

Sameea Qureshi ◽

J. Bracken Burns ◽

...

Keyword(s):

United States ◽

Emergency Medicine ◽

General Surgery ◽

Disaster Preparedness ◽

The United States ◽

General Surgeons

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Operative Confidence Among U.S General Surgery Residents

The American Surgeon ◽

10.1177/00031348211038588 ◽

2021 ◽

pp. 000313482110385

Author(s):

Adel Elkbuli ◽

Haley Ehrlich ◽

Toria Gargano ◽

Kevin Newsome ◽

Huazhi Liu ◽

...

Keyword(s):

General Surgery ◽

Online Survey ◽

Influential Factors ◽

University Teaching ◽

Teaching Hospitals ◽

Binary Outcomes ◽

Case Volume ◽

General Surgery Residency ◽

Operative Case ◽

Community Teaching

Background General surgery residents (GSRs) must develop operative autonomy skills to practice independently after graduation. We aim to investigate perceived confidence and operative autonomy of GSR physicians in order to identify and address influential factors. Methods A 28-question anonymous online survey was distributed to 23 United States general surgery residency programs. Multivariable logistic regression was used for calculating the adjusted odds ratio (aOR) for binary outcomes. Significance was defined as P-values ≤ .05 or 95% confidence intervals (CIs) >1 or <1. Results There were 120/558 (21.5%) GSR respondents. General surgery residents with >200 overall operative case volume reported significantly higher confidence with minor cases (P = .05) and major cases (P = .02). General surgery residents that performed both minor and major surgeries reported higher confidence with minor cases at 85.7% compared to GSRs that performed mostly minor surgeries (64.7%) and mostly major surgeries (62.5%). General surgery residents who performed >50 minor surgeries during their PGY 1 and 2 were less confident with major cases than GSRs who performed <50 minor surgeries (aOR: 19.98, 95% CI: 1.26, 318). General surgery residents from community teaching hospitals reported higher confidence with major and minor cases than GSRs from university teaching hospitals and combined programs. Conclusion Increased case volume, predominant case type, early surgical experience during PGY 1 and 2 years, and training at community teaching hospitals were identified as the most important factors that positively influence perception of operative confidence and autonomy among GSRs. These may have important implications in the development of future surgeons.

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Resident Exposure to Peripheral Nerve Surgical Procedures During Residency Training

Journal of Graduate Medical Education ◽

10.4300/jgme-d-15-00318.1 ◽

2016 ◽

Vol 8 (2) ◽

pp. 173-179 ◽

Cited By ~ 7

Author(s):

Joseph A Gil ◽

Alan H Daniels ◽

Edward Akelman

Keyword(s):

Peripheral Nerve ◽

Plastic Surgery ◽

Surgical Procedures ◽

General Surgery ◽

Orthopaedic Surgery ◽

Case Volume ◽

Peripheral Nerve Surgery ◽

Case Logs ◽

Nerve Surgery ◽

Neurological Surgery

ABSTRACT Variability in case exposures has been identified for orthopaedic surgery residents. It is not known if this variability exists for peripheral nerve procedures.Background The objective of this study was to assess ACGME case log data for graduating orthopaedic surgery, plastic surgery, general surgery, and neurological surgery residents for peripheral nerve surgical procedures and to evaluate intraspecialty and interspecialty variability in case volume.Objective Surgical case logs from 2009 to 2014 for the 4 specialties were compared for peripheral nerve surgery experience. Peripheral nerve case volume between specialties was performed utilizing a paired t test, 95% confidence intervals were calculated, and linear regression was calculated to assess the trends.Methods The average number of peripheral nerve procedures performed per graduating resident was 54.2 for orthopaedic surgery residents, 62.8 for independent plastic surgery residents, 84.6 for integrated plastic surgery residents, 22.4 for neurological surgery residents, and 0.4 for surgery residents. Intraspecialty comparison of the 10th and 90th percentile peripheral nerve case volume in 2012 revealed remarkable variability in training. There was a 3.9-fold difference within orthopaedic surgery, a 5.0-fold difference within independent plastic surgery residents, an 8.8-fold difference for residents from integrated plastic surgery programs, and a 7.0-fold difference within the neurological surgery group.Results There is interspecialty and intraspecialty variability in peripheral nerve surgery volume for orthopaedic, plastic, neurological, and general surgery residents. Caseload is not the sole determinant of training quality as mentorship, didactics, case breadth, and complexity play an important role in training.Conclusions

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Variability in Resident Operative Hand Experience by Specialty

Hand ◽

10.1177/1558944716677537 ◽

2016 ◽

Vol 13 (1) ◽

pp. 103-107 ◽

Cited By ~ 1

Author(s):

Jason Silvestre ◽

Ines C. Lin ◽

L. Scott Levin ◽

Benjamin Chang

Keyword(s):

General Surgery ◽

Orthopedic Surgery ◽

Hand Surgery ◽

The United States ◽

Future Research ◽

General Surgery Residency ◽

Surgery Training ◽

General Surgeons ◽

Case Logs ◽

Recent Attention

Background: Recent attention has sought to standardize hand surgery training in the United States. This study analyzes the variability in operative hand experience for orthopedic and general surgery residents. Methods: Case logs for orthopedic and general surgery residency graduates were obtained from the American Council of Graduate Medical Education (2006-2007 to 2014-2015). Plastic surgery case logs were not available for comparison. Hand surgery case volumes were compared between specialties with parametric tests. Intraspecialty variation in orthopedic surgery was assessed between the bottom and top 10th percentiles in procedure categories. Results: Case logs for 9605 general surgery residents and 5911 orthopedic surgery residents were analyzed. Orthopedic surgery residents performed a greater number of hand surgery cases than general surgery residents ( P < .001). Mean total hand experience ranged from 2.5 ± 4 to 2.8 ± 5 procedures for general surgery residents with no reported cases of soft tissue repairs, vascular repairs, and replants. Significant intraspecialty variation existed in orthopedic surgery for all hand procedure categories (range, 3.3-15.0). Conclusions: As the model for hand surgery training evolves, general surgeons may represent an underutilized talent pool to meet the critical demand for hand surgeon specialists. Future research is needed to determine acceptable levels of training variability in hand surgery.

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Use of the ORBEYETM Exoscope in General Surgery: The Advent of Video-Assisted Open Surgery

Surgical Innovation ◽

10.1177/1553350620965344 ◽

2020 ◽

pp. 155335062096534

Author(s):

Francesco Corcione ◽

Vania Silvestri ◽

Giovanni Merola ◽

Michele Dambra ◽

Ruggero Lionetti ◽

...

Keyword(s):

Inguinal Hernia ◽

High Resolution ◽

Adverse Effects ◽

Hernia Repair ◽

Surgical Procedures ◽

General Surgery ◽

Gold Standard ◽

Open Surgery ◽

Subtotal Gastrectomy ◽

Ivor Lewis

Background. Microsurgery has quickly become the “gold standard” approach for vascular surgical steps during neurosurgery. However, despite its advantages, the microscope has not been widely adopted in general surgery. A new 3D‐surgical exoscope, the ORBEYETM, has been developed and introduced to some surgical specialties. Herein, we present our preliminary experience with the ORBEYETM exoscope as applied to a number of general surgical procedures. Method. Throughout February 2020, 7 patients had undergone varying surgical procedures at our institute utilizing the ORBEYETM in some of specific procedural steps where the surgeons felt that the surgery would benefit from more enhanced magnification. Upon completion, all the surgeons who had taken part in the procedure were asked if they had experienced any nausea, dizziness, or eyestrain during its use. Results. The ORBEYETM was employed in a number of surgical steps for the following procedures: throughout an inguinal hernia repair, during a duodeno-cephalo-pancreatectomy, for a subtotal gastrectomy, during para-aortic mass dissection, and during Ivor Lewis procedure. None of the surgeons involved in the procedures reported experiencing any nausea, dizziness nor eyestrain, nor any other physical discomforts. Conclusion. To the best of our knowledge, ours is the very first report on the employment of the ORBEYE exoscope during general surgery. Our experience assures us that this highly ergonomic technology with its high-resolution 4K 3D optical system allows the surgeon to perform safe and precise surgery in several dedicated steps in which adequate magnification is required with no adverse effects to the surgeon or the surgical procedure itself.

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Does operative experience during residency correlate with reported competency of recent general surgery graduates?

Canadian Journal of Surgery ◽

10.1503/cjs.020811 ◽

2012 ◽

pp. S171-S177

Author(s):

Arash Safavi ◽

Sarah Lai ◽

Sonia Butterworth ◽

Morad Hameed ◽

Dan Schiller ◽

...

Keyword(s):

General Surgery ◽

Alimentary Tract ◽

Resident Education ◽

Response Rate ◽

Surgical Experience ◽

Questionnaire Response ◽

Case Volume ◽

Operative Case ◽

Recent Graduates ◽

Survey Responses

Background: Identification of attributes of residency training that predict competency would improve surgical education. We hypothesized that case experience during residency would correlate with self-reported competency of recent graduates. Methods: Aggregate case log data of residents enrolled in 2 general surgery programs were collected over a 12-month period and stratified into Surgical Council on Resident Education (SCORE) categories. We surveyed recent (< 5 yr) residency graduates on procedural competency. Resident case volumes were correlated with survey responses by SCORE category. Results: In all, 75 residents performed 11 715 operations, which were distributed by SCORE category as follows: essential-common (EC) 9935 (84.8%), essential-uncommon (EU) 889 (7.6%) and complex 891 (7.6%). Alimentary tract procedures were the most commonly performed EC (2386, 24%) and EU (504, 56.7%) procedures. The least common EC procedure was plastic surgery (4, 0.04%), and the least common EU procedure was abdomen–spleen (1, 0.1%). The questionnaire response rate was 45%. For EC procedures, self-reported competency was highest in skin and soft tissue, thor acic and head and neck (each 100%) and lowest in vascular–venous (54%), whereas for EU procedures it was highest in abdomen–general (100%) and lowest in vascular–arterial (62%). The correlation between case volume and self-reported competency was poor (R = 0.2 for EC procedures). Conclusion: Self-reported competency correlates poorly with operative case experience during residency. Other curriculum factors, including specific rotations and timing, balance between inpatient and outpatient surgical experience and competition for cases, may contribute to procedural competency acquisition during residency.

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