1398. Influence of the ACGME Residency Requirements on the Choice of Treatment Modality for Aneurysms

Authors: Leonardo B. C. Brasiliense, MD; Travis Dumont, MD (Tucson, AZ)

Introduction: In July of 2016, the ACGME implemented a significant change in the national requirement for aneurysm treatment during neurosurgery residency. By previous standards, neurosurgery graduates were expected to have 40 open and 10 endovascular cases which was changed to a combination of 50 cases in either modality. We hypothesized that the ACGME’s decision would result in a decrease in the proportion of aneurysms being treated with microsurgery in Academic Medical Centers. Methods: ACGME resident case logs were reviewed and analyzed between 2009 and 2018. The average number of open and endovascular aneurysm cases was obtained and compared to a national database from the University HealthSystem Consortium (UHC). Pearson’s correlation was calculated between groups. Results: Between 2009 and 2016 the average number of open aneurysm cases by neurosurgery graduates increased by 2.1%, from 37.7 ( ± 26) to 38.5 ( ± 34), while the number of endovascular aneurysm cases increased 3.6-fold, from 4.6 ( ± 16) to 16.9 ( ± 7). Following the ACGME’s change in resident requirements there was a 15% decrease in open aneurysm cases between 2016 and 2018 to 32.5 ( ± 20) while the number of endovascular cases increased 26% during the same period to 21.3 ( ± 35). During the study period, the total number of aneurysm cases increased by 27%. Pearson's correlation showed that the decrease in open aneurysm cases was significantly correlated to an increase in endovascular cases (R= -0.74, p=0.01). At the same time, the proportion of open aneurysm cases decreased by 9% after July 2016 according to the UHC database while the total number of endovascular cases increased by 19%. Conclusion: Our analysis suggests that the ACGME’s decision to remove specific requirements for open aneurysm treatment had a negative impact on neurosurgical training, resulting in an accelerated decline in microsurgical cases.