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Microsurgery Case Volume During Orthopaedic Surgery Residency: A 7-Year Assessment
Richard M. Hinds, MD; Christopher Klifto, MD; Michael Guss, MD; John T. Capo, MD
NYU Hospital for Joint Diseases, New York, NY
Introduction: Microsurgery is a specialized technique utilized in many areas of modern surgery, particularly among hand surgeons. The purpose of this study was to assess trends in orthopaedic resident case volume for microsurgery procedures and to assess caseload variation among residents. We hypothesized that considerable discrepancies subsist among residents regarding microsurgery case volume.
Methods: Accreditation Council for Graduate Medical Education (ACGME) orthopaedic surgery resident case logs were reviewed for graduating years 2007 to 2013. ACGME data is based upon primary role procedures logged by residents. The mean number of adult, pediatric, and total microsurgery cases performed by residents were noted. Additionally, the median number of microsurgery procedures performed by the 90th, 50th, and 10th percentiles of residents (by case volume) was recorded. Changes in case volume over time were calculated utilizing linear regression analyses. The level of significance for all tests was P < 0.05.
Results: The mean number of adult (24.5 to 41.9; P = 0.01), pediatric (1.9 to 3.4; P = 0.011), and total (26.3 to 45.3; P = 0.01) microsurgery procedures performed by residents increased significantly during the 7-year period (Table 1). Similarly, residents in both the 90th (63 to 109; P = 0.01) and 50th (10 to 21; P = 0.036) percentiles sustained significant increases in the median number of microsurgery procedures (Figure 1). No change was noted for residents in 10th percentile (0 to 0; P > 0.999). Graduating residents in the 90th percentile performed 6 times more microsurgery procedures than residents in the 50th percentile.
Conclusion: Microsurgical caseload is increasing among graduating orthopaedic residents with growth concentrated among residents in the 90th and 50th percentiles. Substantial variability in resident microsurgery case volume exists. Future investigations are needed to explore the educational implications of these findings and should seek to correlate microsurgical caseload with competency.
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