Surgical registrars’ exposure to trauma laparotomy: A retrospective study from a level 1 trauma centre in New Zealand

Abstract

• General surgical registrars in New Zealand have limited exposure in performing trauma laparotomies. • Limited exposure to performing trauma laparotomies may negatively impact a registrar's performance in this procedure once they finish training. • A post-fellowship education and training in trauma may help meet this need in trauma training. The objective of this study was to review the experience of surgical registrars in performing trauma laparotomies at a level 1 trauma centre in New Zealand, and to benchmark this exposure against the current literature on the topic. A cohort study was conducted retrospectively at a level 1 trauma centre, Waikato Hospital, Hamilton, New Zealand. All patients (>15 years) who underwent a laparotomy for trauma between 2012 and 2020 were included. These patients were stratified by the study conductors retrospectively, according to each case's primary operator and compared the experience of each respective operator according to the time of day and by the mechanism of injury. During the 9-year study period, a total of 204 trauma laparotomies were performed at Waikato Hospital. Of these 204 laparotomies, a consultant was present in 78% (160/204). In 27% of cases, a registrar was the primary operator with a consultant present (55/204), and in 22% of cases, the registrar was the primary operator with no consultant present (44/204). In 48%, a registrar assisted a consultant (98/204), and in 3%, a consultant performed the operation without a registrar assisting (7/204). Based on there being four registrars rotating through Waikato Hospital each 6-month cycle, this would imply that each registrar would be exposed to three trauma laparotomies each cycle. Despite significant institutional volumes, the exposure of individual New Zealand surgical registrars to trauma laparotomy is limited. In addition, most trauma laparotomies were performed by registrars as assistants rather than as primary operators. It is hoped that the newly launched Post Fellowship Education and Training (PFET) in trauma in Australasia will provide greater exposure to surgeons who will be managing trauma in the future.