BACKGROUND The impact of integrated vascular surgery (VS) residency (0 + 5) programs on general surgery (GS) resident and VS fellow (5 + 2) operative volume has not been investigated on a national scale. METHODS Accreditation Council for Graduate Medical Education (ACGME) case logs were reviewed for GS resident, VS resident, and VS fellow operative volume from 2001-2021. Integrated VS resident data was available from 2012-2021, corresponding with the introduction of the 0 + 5 paradigm. Trends in operative volume were evaluated via linear regression analysis. RESULTS The national cohort of chief GS resident graduates increased from 1005 to 1357 per year. Total operative volume also increased from 932 to 1039 cases (+7.4 cases/yr, R2 = .80, P < .0001) among GS residents. Major vascular cases decreased among GS residents from 138 to 101 cases (-2.4 cases/yr, R2 = .58, P < .0001) with a decrease in proportion of chief-level vascular cases from 30.4% to 11.9% (-1.0%/yr, R2 = .92, P < .0001). Palliative procedures (amputations and hemodialysis access) comprised a significant proportion of GS cases (median 44.7%). Concurrently, integrated VS graduates increased from 11 to 37 per year, with an increase in major vascular case volume from 506 to 658 cases (+18.4 cases/yr, R2 = .63, P = .01). Total VS fellow major case volume also increased from 369 to 444 cases (+3.5 cases/yr, R2 = .73, P < .0001). CONCLUSIONS The introduction of the 0 + 5 intgrated VS residency paradigm has correlated with a significant decrease in GS operative experience in major vascular procedures on a national level. Traditional VS fellow case volume does not appear to be impacted by 0 + 5 integrated residents. Further analysis with program-level data may help to explain the causative relationship of these findings.

中文翻译：

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综合血管外科住院医师对普通外科住院医师和血管研究员手术量的影响：全国分析。

背景 综合血管外科 (VS) 住院医师 (0 + 5) 计划对普通外科 (GS) 住院医师和 VS 研究员 (5 + 2) 手术量的影响尚未在全国范围内进行调查。方法 研究人员医学教育认证委员会 (ACGME) 审查了 2001 年至 2021 年期间 GS 住院医师、VS 住院医师和 VS 同行手术量的病例日志。2012 年至 2021 年期间提供了综合 VS 居民数据，与 0 + 5 范式的引入相对应。通过线性回归分析评估手术量的趋势。结果 全国 GS 住院医师毕业生人数每年从 1005 人增加到 1357 人。GS 居民的总手术量也从 932 例增加到 1039 例（+7.4 例/年，R2 = .80，P < .0001）。GS 居民的主要血管病例从 138 例减少到 101 例（-2.4 例/年，R2 = .58，P < .0001），首席级血管病例比例从 30.4% 下降到 11.9%（-1.0%）年，R2 = .92，P < .0001)。姑息治疗（截肢和血液透析）在 GS 病例中占很大比例（中位数 44.7%）。同时，综合 VS 毕业生从每年 11 名增加到 37 名，主要血管病例数量从 506 例增加到 658 例（+18.4 例/年，R2 = .63，P = .01）。VS 主要病例总数也从 369 例增加到 444 例（+3.5 例/年，R2 = .73，P < .0001）。结论 0 + 5 综合 VS 住院医师范式的引入与全国范围内主要血管手术的 GS 手术经验显着下降相关。传统 VS 同胞病例量似乎并未受到 0+5 综合居民的影响。对程序级数据的进一步分析可能有助于解释这些发现的因果关系。