INCREASING SURGEON FLEXIBLE ENDOSCOPY UTILIZATION: A RETROSPECTIVE REVIEW OF TEN YEARS OF FELLOW CASE NUMBERS
David Morrell*1, Cheyenne C. Sonntag1, Amber Schilling1, Jose M. Martinez3, Jeffrey M. Marks2, Eric Pauli1
1Penn State Health Milton S. Hershey Medical Center, Hershey, PA; 2Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH; 3University of Miami Health System, Miami, FL
Introduction
Endoscopy continues to be an important aspect of surgical practice. However, the volume of surgical endoscopy cases performed annually remains relatively unknown. This study utilizes the endoscopic case logs of surgical fellows to estimate trends in surgical endoscopic practice.
Methods
A retrospective analysis was performed on deidentified case logs of 1,613 surgery fellows who began fellowship training between 2007-2016. All fellows were enrolled in an accredited surgery fellowship program by The Fellowship Council. Fellows were grouped by year of fellowship matriculation and further subcategorized by type of fellowship program. Mean number of flexible endoscopy cases per fellow was calculated by year and further subcategorized by endoscopic subcategory. Trends in mean endoscopy cases per fellow were assessed for linearity and fitted with least squares linear regression to model anticipated mean endoscopy cases in 2021 and 2026.
Results
Of the 1,613 fellows, 725 were enrolled in advanced GI, 667 in bariatric, 67 in colorectal, 49 in hepatobiliary, 43 in thoracic, 39 in flexible endoscopy, 7 in foregut, and 16 in uncategorized fellowships. Mean annual flexible endoscopy cases per fellow was 93.5 (15.3 diagnostic colonoscopy, 2.9 therapeutic colonoscopy, 63.1 diagnostic upper endoscopy, 12.0 therapeutic upper endoscopy, 0.2 other) and ranged from 0 to 1,072 cases. This represented an increase from mean of 78.0 cases for fellows matriculating in 2007 to 100.1 cases in 2016 (28.3% increase). This resulted from increased diagnostic upper endoscopy (mean of 45.9 in 2007 to 69.9 in 2016, 52.4% increase) and therapeutic upper endoscopy (mean of 9.9 in 2007 to 13.8 in 2016, 40.1% increase). This accompanied a 21.5% increase in number of fellows (135 in 2007 to 164 in 2016). Half (51.1%) of diagnostic upper endoscopy was performed intraoperatively. A least squares linear regression was modeled on both total endoscopy (r2 0.83), total diagnostic upper endoscopy (r2 0.82) cases, and total therapeutic upper endoscopy (r2 0.73). Projected mean total endoscopy cases per fellow is 127.7 in 2021 and 146.1 in 2026, mean diagnostic upper endoscopy is 90.3 in 2021 and 105.0 in 2026, and mean therapeutic upper endoscopy is 19.0 in 2021 and 22.8 in 2026.
Conclusions
Despite increasing numbers of surgical fellows, endoscopic cases per fellow increased and is projected to continue to increase. Most of this growth comes from increased intraoperative endoscopic guidance, but also reflects increasing therapeutic use. Current efforts to increase endoscopic exposure in surgical residencies and fellowships are well warranted as endoscopy continues to be an important aspect of surgical practice. Further attention to improve the fellow case log system is necessary to better track these efforts.
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