Abstract
Introduction
In the United States, there is an anticipated critical shortage of vascular surgeons
in the coming decades. The shortage is expected to be particularly pronounced in rural
areas. Our institution serves a rural and underserved population in which the incidence
and prevalence of cardiovascular disease continues to rise. Our institution maintains
a general surgery residency and has all the required Accreditation Council for Graduate
Medical Education (ACGME) rotations and educational infrastructure to support a vascular
surgery fellowship. This study aims to analyze the vascular caseload at our institution
to determine if we and other institutions with similar surgical volumes can support
the creation of a 2-year vascular fellowship.
Methods
A single-site retrospective review of the number and type of vascular cases conducted
at our institution between July 2016 and June 2021 was performed. The procedures were
grouped into the following ACGME-defined categories: abdominal, cerebrovascular, complex,
endovascular aneurysm repair, endovascular diagnostic or therapeutic, and peripheral.
The total number and annual average for each category was obtained. Using the annual
average, a 2-year estimate was calculated and compared to the ACGME minimum for each
category. Our 2-year estimate was then compared to the national average for graduating
vascular surgery fellows in order to generate a z-score for each category.
Results
In the specified period, 6100 total surgical procedures were performed by three vascular
surgeons at our institution. Two thousand five hundred and seventy-eight of the 6100
procedures met at least one of the ACGME-defined category requirements. Our center
greatly exceeded the requirements for each category except for abdominal. This is
consistent with trends observed in most centers across the nation, which are seeing
a decline in open repairs across all categories, especially in open abdominal repairs.
Our center's vascular case volume shows no significant difference the national average
in each ACGME category (P ≥ 0.05 for all).
Conclusions
Despite our center's large vascular caseload and need for more vascular providers,
there were not enough open abdominal cases performed to support the training of a
vascular fellow. Given the continued decline in open aortic volume across the country,
we anticipate that rural centers similar to our own will have difficulty establishing
programs to train and recruit vascular surgeons. Flexibility in the abdominal category
requirement or creation of open aortic fellowships may be necessary for smaller rural
centers to train vascular surgeons and meet the future needs of the specialty.
Keywords
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Article info
Publication history
Published online: November 26, 2022
Accepted:
November 8,
2022
Received in revised form:
May 3,
2022
Received:
February 27,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
