Variability in Experience Performing Lower Extremity Amputations Between Surgical Residents: An Examination Of ACGME Case Logs.

Background There is a wide array of indications for lower extremity amputation (LEA) and inherent variability in operative experiences between surgical residents. Significant variation in resident surgical experience performing LEAs is possible. Objective To identify inter- and intra-specialty trends and variability in LEA experience in graduating orthopedic surgery, general surgery, and vascular surgery residents from 2007-2017. Methods Publicly available ACGME case log data for above knee amputation, below knee amputation, and transmetatarsal/ digital amputation procedures from accredited orthopaedic surgery, general surgery, traditional (5+2) vascular surgery and integrated (0+5) vascular surgery residencies was reviewed from 2007-2017. Linear regression analysis was used to identify temporal trends, with statistical significance set at p<0.05. Results From 2007-2017, the mean number of total LEA, AKA, and BKA performed by graduating orthopaedic surgery residents did not change significantly. The mean number of total LEAs logged by graduating general surgery and integrated (0+5) vascular surgery residents did not change significantly over time (p=0.98, p=0.23, respectively). The mean number of total LEAs logged by traditional (5+2) vascular surgery residents increased from 16.0 to 32.6 (p<0.01). As study year increased, graduating integrated (0+5) and traditional (5+2) vascular surgery residents logged more LEAs relative to graduating orthopaedic surgery and general surgery residents (p<0.01). Conclusions There is significant variation in resident experience in LEAs between surgical specialties. Integrated vascular surgery residents logged the most LEAs, followed by traditional vascular surgery residents, orthopaedic surgery residents, and general surgery residents. Experience of orthopaedic surgery residents in LEAs has been relatively stable over time.Level of Evidence: IV.