Impact of Transitioning to a Level 1 Trauma Center on Orthopaedic Surgical Volume and Resident Education: Case Report in Orthopaedic Education.

Abstract

Background: Orthopaedic residents are required to complete at least 1,000 surgical cases over their 5-year training, including specific procedural categories mandated by the Accreditation Council for Graduate Medical Education (ACGME). This study evaluates the effects of upgrading a major academic center to an adult Level 1 trauma center (L1TC) on orthopaedic case volume, complexity, and residents' training experience. In 2018, our institution transitioned from a Level 3 to a L1TC. We retrospectively analyzed surgical records and resident case logs spanning from 2013 to 2023.

Methods: ACGME case logs and electronic medical records (EMRs) from a single urban institution were reviewed from July 2013 to June 2023. Data were divided into pre-L1TC (2013-2018) and post-L1TC (2018-2023) periods. Trauma cases were defined by ACGME Current Procedural Terminology (CPT) codes in the "fracture/dislocation" and "manipulation" categories and further identified by criteria such as treatment by orthopaedic trauma surgeons, emergent scheduling, or occurrence on weekends or holidays. All other cases were categorized as elective. Linear regression analyses assessed trends in case volumes over time.

Results: Total ACGME cases logged ranged from 6,172 in 2015 to 10,541 in 2018, without a significant trend over time (p = 0.17). Trauma logs increased significantly post-L1TC (p < 0.001), with an average of 2,586 (31% of all cases) compared with 1,467 (22%) pre-L1TC. Trauma case volume saw a near 12-fold increase post-L1TC (p < 0.001). Elective cases remained stable (p = 0.48) but decreased significantly during the COVID-19 pandemic (p = 0.0035).

Conclusions: The shift to L1TC status significantly boosted trauma case exposure for residents without an observed displacement of elective cases in favor of trauma cases. Elective cases declined during the pandemic, emphasizing the role of L1TC access in sustaining training. Future studies should investigate the impact of the L1TC experience on early career proficiency in orthopaedic practice. These findings underscore the value of trauma center access in resident training and support further exploration into optimizing orthopaedic education.

Level of evidence: Level V, Case report. See Instructions for Authors for a complete description of levels of evidence.