Has nonoperative management of solid visceral injuries adversely affected resident operative experience?

The purpose of this study was to assess the impact of increased use of nono perative management of blunt injuries to the spleen or liver on surgical re sidents' operative experience with solid visceral injuries. We conducted a 10-year retrospective study of blunt spleen and liver injuries at a state-d esignated Level I trauma center and a survey of chief residents' operative experience with splenic and hepatic injuries from blunt trauma during the s ame time period. From 1990 through 1999, 431 patients were admitted with sp lenic injuries and 634 patients were admitted with liver injuries; 350 sple nic injuries (81%) were due to blunt trauma; 317 liver injuries (50%) were caused by blunt mechanisms. In 1990 100 per cent of patients with splenic i njuries and 93 per cent of those with liver injuries underwent surgery for those injuries. These rates were 19 and 28 per cent respectively in 1999. T he number of patients with blunt solid visceral injuries increased more tha n fourfold from 1990 through 1999. The number of operations for splenic and hepatic injuries performed by chief residents did not decline significantl y during this time period (5.5 cases per chief resident in 1990; 4.6 cases per chief resident in 1999). The increased numbers of patients with solid v isceral injuries were due to two factors: increased proportion of blunt tra uma admissions especially from motor vehicle collisions and improved recogn ition of spleen and liver injuries by expanded use of CT scans. We conclude that nonoperative management of blunt solid visceral injuries does not nec essarily lead to a diminution of operations nor jeopardize resident educati on. However, trauma volumes must be high enough to support adequate operati ve experience.