Comparison of orthopaedic specialty registrar training opportunities in trusts with and without an elective surgical hub: a review of administrative data.

Introduction: During the COVID-19 pandemic in England, orthopaedic surgery trainees experienced a reduction in training opportunities due to periods of elective surgery suspension. We aimed to explore training opportunities for orthopaedic trainees in trusts with and without access to an elective surgical hub.

Methods: This retrospective analysis of administrative data used eLogbook data for registrars who performed six high-volume, low-complexity orthopaedic procedures in NHS hospitals in England between April 2017 and March 2023. Data included training grade, role in the procedure, trust where the procedure was performed and procedure date. These were linked to Hospital Episodes Statistics (HES) data on the total number of these procedures conducted during the study period and whether the trust hosted or fed into an elective surgical hub at the time of the procedure.

Results: Data were analysed for 1,755 trainees acting as first surgeon in 125,759 procedures. Trusts with access to an elective surgical hub significantly increased the proportion of procedures conducted by a trainee compared with non-hub trusts over the study period. Most of the increase in trainee involvement was associated with more senior trainees (ST6-8). The proportional increase was not enough to offset the decline in the absolute number of procedures conducted by trainees (25,598 (2017-2018), 21,057 (2022-2023)).

Conclusions: Elective surgical hubs have made a positive contribution to training opportunities for orthopaedic trainees but not enough to offset the post-pandemic fall in activity. The number of procedures conducted in NHS hospitals and the rate of training opportunities must be increased.