Maintaining surgical skills in an era of declining trauma surgery cases: insights from 12 years of trauma surgery experience in a surgical residency program facility

Background Unlike in Western countries, trauma center consolidation has not progressed in Japan. This raises the question of who are the appropriate providers for the decreased number of trauma surgeries. Emergency surgeons performing trauma surgeries lack sufficient cases for skill refinement, while on the other hand, surgeons performing elective surgeries face the dilemma of not being able to handle trauma across organs due to subspecialization. In this context, our institution has deliberately not pursued subspecialization and has been addressing various trauma surgery cases by regularly handling a wide range of general surgery fields. Objective and methods We examined the types, sites, target organs, and procedures of trauma surgeries performed under general anesthesia at our institution from April 2012 to December 2023. Additionally, we investigated the content and annual trends of non-trauma surgeries performed during the same period to assess the appropriateness of general surgeons handling trauma surgeries and to consider future sustainability. Results Trauma surgeries averaged around six cases per year, accounting for approximately 1% of the total surgeries performed. Most surgeries were related to abdominal organs, which could mostly be managed with techniques from the field of gastrointestinal surgery. Although there were fewer cases, it seemed possible to handle surgeries for neck, chest, and vascular trauma through routine clinical practice such as thyroid surgery, lung and mediastinal tumor surgeries, and peripheral vascular surgeries. Issues identified include a decrease in non-gastrointestinal cases as subspecialization progresses, and an increasing proportion of laparoscopic surgeries leading to a rise in inexperienced young surgeons in open surgery. Conclusion Handling trauma surgeries with fewer cases seemed possible by broadly addressing the scope of general surgery in routine clinical practice.