How did general surgery resident operative volume change during the first 4 months of the US COVID-19 pandemic, and were all postgraduate year levels equally affected?
In this review of 1358 resident case logs, general surgery resident operative volume declined by 33.5% in March to June 2020 compared with March to June 2018 and 2019 and affected residents in every level of training.
These findings illustrate the significant negative effect of the COVID-19 pandemic on general surgery resident operative experience, highlighting the importance of identifying future mitigation strategies.
The suspension of elective operations in March 2020 to prepare for the COVID-19 surge posed significant challenges to resident education. To mitigate the potential negative effects of COVID-19 on surgical education, it is important to quantify how the pandemic influenced resident operative volume.
To examine the association of the pandemic with general surgical residents’ operative experience by postgraduate year (PGY) and case type and to evaluate if certain institutional characteristics were associated with a greater decline in surgical volume.
Design, Setting, and Participants
This retrospective review included residents’ operative logs from 3 consecutive academic years (2017-2018, 2018-2019, and 2019-2020) from 16 general surgery programs. Data collected included total major cases, case type, and PGY. Faculty completed a survey about program demographics and COVID-19 response. Data on race were not collected. Operative volumes from March to June 2020 were compared with the same period during 2018 and 2019. Data were analyzed using Kruskal-Wallis test adjusted for within-program correlations.
Main Outcome and Measures
Total major cases performed by each resident during the first 4 months of the pandemic.
A total of 1368 case logs were analyzed. There was a 33.5% reduction in total major cases performed in March to June 2020 compared with 2018 and 2019 (45.0 [95% CI, 36.1-53.9] vs 67.7 [95% CI, 62.0-72.2]; P < .001), which significantly affected every PGY. All case types were significantly reduced in 2020 except liver, pancreas, small intestine, and trauma cases. There was a 10.2% reduction in operative volume during the 2019-2020 academic year compared with the 2 previous years (192.3 [95% CI, 178.5-206.1] vs 213.8 [95% CI, 203.6-223.9]; P < .001). Level 1 trauma centers (49.5 vs 68.5; 27.7%) had a significantly lower reduction in case volume than non–level 1 trauma centers (33.9 vs 63.0; 46%) (P = .03).
Conclusions and Relevance
In this study of operative logs of general surgery residents in 16 US programs from 2017 to 2020, the first 4 months of the COVID-19 pandemic was associated with a significant reduction in operative experience, which affected every PGY and most case types. Level 1 trauma centers were less affected than non–level 1 centers. If this trend continues, the effect on surgical training may be even more detrimental.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Corresponding Author: Farin Amersi, MD, Department of Surgery, Cedars-Sinai Medical Center, 8700 Beverly Blvd, #8215NT, Los Angeles, CA 90048 (email@example.com).
Accepted for Publication: March 4, 2021.
Published Online: April 30, 2021. doi:10.1001/jamasurg.2021.1978
Author Contributions: Dr Amersi had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Purdy, de Virgilio, Shields Frey, Neville, Donahue, Calhoun, Spain, Amersi.
Acquisition, analysis, or interpretation of data: Purdy, de Virgilio, Kaji, Shields Frey, Lee-Kong, Inaba, Gauvin, Neville, Smith, Salcedo, Calhoun, Poola, Namm, Spain, Dickinson, Tanner, Wolfe, Amersi.
Drafting of the manuscript: Purdy, de Virgilio, Tanner, Amersi.
Critical revision of the manuscript for important intellectual content: Purdy, de Virgilio, Kaji, Shields Frey, Lee-Kong, Inaba, Gauvin, Neville, Donahue, Smith, Salcedo, Calhoun, Poola, Namm, Spain, Dickinson, Wolfe, Amersi.
Statistical analysis: Kaji.
Administrative, technical, or material support: Purdy, Shields Frey, Lee-Kong, Gauvin, Neville, Donahue, Smith, Namm, Spain, Dickinson, Tanner.
Supervision: de Virgilio, Shields Frey, Calhoun, Poola, Amersi.
Conflict of Interest Disclosures: Dr Smith reports personal fees from Stryker Endoscopy outside the submitted work. No other disclosures were reported.
Disclaimer: Dr Kaji is Statistical Editor of JAMA Surgery but was not involved in any of the decisions regarding review of the manuscript or its acceptance.
Meeting Presentation: This study was accepted for presentation at the 92nd Annual Meeting of the Pacific Coast Surgical Association that was planned for February 18-20, 2021, in Monterey, California. However, owing to the COVID-19 pandemic, the meeting was canceled.
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