An Interval Look at the Transplant Surgery Pipeline: Insights from General Surgery Residents' Operative Experience Using ACGME Operative Logs from 2000 to 2021

Abstract

Objective: Given the declining number of US graduates pursuing transplant surgery as well as regulatory changes regarding transplant rotations for surgical residents, this study examined the transplant surgery operative volume of residents over the past 20 years.

Design: Retrospective analysis of the ACGME database of general surgery operative logs from academic year (AY) 1999-2000 to AY 2020-2021; data was categorized into time periods relative to regulatory changes: Period 1 (1999-2010) and Period 2 (2011-2021).

Setting/participants: All ACGME-accredited general surgery residency programs in the US.

Findings: On average, the proportion of transplant cases to all total major cases was about 1% and did not change during the study period (p=0.61). Each graduating resident completed an average of 10.0 ± 11.0 cases during Period 1 and 10.8 ± 12.0 cases during Period 2, representing a statistically but unlikely clinically significant increase (p=0.008). Renal transplants comprised more than 50% of each resident's operative experience in transplant surgery. The proportion of resident involvement in all renal and liver transplantations nationally did not change during the study period, ranging from 34.5-42.9% for renal and 13.8-22.4% for liver.

Conclusions: Resident volume in transplant surgery has largely remained consistent over the past 20 years, suggesting that changes in operative volume are unlikely driving declining interest in transplant surgery fellowship among US trainees.

Keywords: ACGME case logs; General surgery residency; Transplant surgery.