EP406 - What to Expect in the First Year of Practice: Operative Trends Among Newly Hired Colorectal Surgeons at an Academic Center

Purpose/Background: The shift from fellowship to independent practice represents a steep and transformative phase in a colorectal surgeon's career. While the ACGME defines training case requirements, there is currently limited data on the operative trends of newly independent colorectal surgeons. Understanding the types and volume of cases performed in an early surgeon's first year can help define realistic expectations as well as inform departmental mentorship and onboarding strategies. This study aims to describe the operative case mix, procedural diversity, and adoption of robotic approaches among newly hired colorectal surgeons during their first year in a tertiary academic center.

Methods/Interventions: A retrospective descriptive analysis was conducted of operative and endoscopic case logs from seven colorectal surgeons during their first 12 months of independent practice (2011-2024). Procedures were categorized by type (colectomy, anorectal, endoscopic, or stoma-related) and operative approach (open, laparoscopic, robotic). When multiple procedures occurred in a single operation, the dominant procedure was recorded for primary analysis, while adjunct procedures were logged separately. Conversions from laparoscopic to open were categorized by the final operative approach. Descriptive statistics were used to summarize procedural counts and approach distributions. Surgeons were divided into three cohorts to evaluate temporal trends in approach adoption: 2011-2014 (2 new hires), 2014-2019 (3 new hires), 2020-2024 (2 new hires).

Results/Outcomes: Across the colorectal surgeons evaluated in this study, the median first-year case volume was 189 procedures per year (range 151-245). On average, a first year attending performed 67 colectomies (39-89), 2 proctectomies (1-4), 65 exams under anesthesia (53-77), 12 hemorrhoidectomies (4-16), 16 fistula procedures (12-23) and 12 anal fissure procedures/biopsies (6-19). Amongst the seven surgeons, 4 ileal pouch anastomosis, 2 ventral mesh rectopexies, and 1 sphincteroplasty were performed. A shift toward robotic approaches was observed in recent cohorts, with robotic colectomies replacing laparoscopic and open cases (Figure 1). Right and sigmoid resections predominated among colectomies.

Conclusion/Discussion: In their first year of practice at the presented tertiary academic center, colorectal surgeons performed a high and diverse case volume, ranging from large abdominal resections to complex anorectal procedures. Over time, operative patterns reflect both technical breadth and progressive adoption of robotic surgery. These findings provide a benchmark for expected first-year experience in a tertiary academic colorectal practice and could be used for future training modeling.

Figure 1: Average procedures per attending cohort in first year of practice