BN SO37 - Upper GI surgical training in the UK: Are there enough training opportunities? 10-year trends in Benign Upper GI index procedures and the impact of COVID-19

Abstract Background Surgical training was adversely impacted during the COVID pandemic, with reports of reduced logbook numbers and challenges in meeting training competencies. Despite a national elective care recovery plan, and interventions aimed at maintaining training opportunities, waiting list expansion has continued and has particularly impacted benign procedures. Upper GI trainees are all required to achieve “Level 4” (independent) competence in Cholecystectomy and Antireflux surgery, however there are anecdotally. fewer opportunities in the post-COVID era to train in these procedures. This study aimed to evaluate trends in these index procedures and to compare the pre- and post- COVID eras. Method The annual Admitted Patient Care (APC) publications draw on Hospital Episode Statistics and summarise activity for each financial year by OPCS4 codes. Codes pertaining to cholecystectomy and antireflux surgery (the “Benign Upper GI” competences on the Joint Committee of Surgical Training New Curriculum Checklist) were screened for inclusion. Data were extracted from APC publications between 2013 and 2023. These data were summarised in a Microsoft Excel Spreadsheet, categorised by index procedure and divided into pre-covid (2013-2019) and post-covid (2019-2023). Trends were evaluated using a Mann-Kendal Non-Seasonal Trend Test. Comparisons were undertaken using a two tailed unpaired t-test. Results Between 2013 and 2023 there was a statistically significant negative annual trend in the number of cholecystectomies from 75934 to 68182 (p=0.02), with a minimum of 47803 in the 2020-2021 financial year and a non-significant positive trend in the subsequent years. There were significantly fewer cholecystectomies in the 4 years following COVID (mean 77357 vs 63882, p=0.015). Antireflux procedures also underwent a significant negative trend from 5467 to 4745 (p=0.02), with a minimum of 2565 in the 2020-2021 financial year and a non-significant positive trend in subsequent years. Mean post-COVID antireflux procedures were also significantly lower (5548 vs 4256, p=0.03). Conclusion The procedures required for training in Benign Upper GI surgery in the UK are occurring with lower frequency than before the COVID pandemic. Whilst this may reflect ongoing operational pressures, or changes in clinical practice, this evidence suggests that training opportunities are now less frequent. This highlights the importance of focussed training and an awareness of training needs amongst both trainees and their mentors.