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IMPLICATIONS OF COVID-19 ON GENERAL SURGERY RESIDENT CASE NUMBERS
W Morgan, K Sevensma, R Douglass
Grand Rapids Medical Education Partners

Background
The COVID-19 pandemic has led to an unprecedented time in general surgery residency training. The effects of the SARS-CoV2 virus have led to a decrease in surgical referrals from primary care offices and a recommendation from the American College of Surgeons to reschedule elective procedures causing a decrease in elective surgical procedures. With a total of 850 major cases recommended prior to graduation, general surgery residents rely on elective surgical procedures throughout their training to become proficient in surgical procedures expected of them upon completion.

Methods
We retrospectively reviewed general surgery case logs from three institutions, Metro Health-University of Michigan Health in Wyoming, MI, Ascension Genesys Hospital in Grand Blanc, MI, and Henry Ford Allegiance Health in Jackson, MI from March 1st to April 30th of 2020 and compared that to the same time period in 2017, 2018, and 2019. The case logs of PGY 1 through PGY 5 residents were included. The data were then analyzed among case types. Case logs were examined from all graduating chief residents in 2017, 2018, and 2019 to determine the average number of cases at graduation.

Results
The mean cases for the resident cohort during 2017, 2018, and 2019 was 1644. The number of cases for 2020 was 880. This notes a 46.47% decrease (P value 0.01) in overall cases performed for our surgical cohort of residents in 2020 during the COVID19 pandemic. Emergency general surgery cases in example, appendectomy, were decreased by 12.5% but elective cases in example, ventral and inguinal hernias, were decreased by 63.8%.

Conclusion
SARS CoV2 has caused an overall decrease of 46.47% in general surgery cases at our institution. Emergency general surgery cases noted an 12.5% decrease during the first two months of the pandemic, but elective cases noted a 63.8% decrease.
We are recommending that once the COVID-19 pandemic has concluded, overall, elective, and emergent surgical case numbers should be examined to note the effect of the pandemic specifically on case types and overall case numbers of surgical residents to ensure that the pandemic has not adversely affected residentsí abilities to meet ACGME requirements for specific case types for graduation.


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