409 The Elusive Appendix: Are Trainees Getting Enough Operative Exposure? A Retrospective Study from a District General Hospital

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Abstract Aim Appendicectomies are index procedures for core surgical training and used to shortlist applicants for higher surgical training. We aimed to evaluate the opportunities available for core trainees (CTs) to perform appendicectomies at a busy district general hospital. Method A retrospective review of all appendicectomies performed at a busy district general hospital between December 2023 and June 2024 was conducted. Data on patient demographics, surgeon grade, intra-operative findings/case complexity, and surgical duration were collected. Results 265 appendicectomies were performed, with 261 completed laparoscopically (98%) and 4 converted to open (2%). Intra-operative findings included 177 inflamed (67%), 53 perforated (20%), 10 mass (4%), and 22 normal appendices (8%). Registrars performed the majority (n=172; 65%), comprising 123 inflamed (71%), 33 perforated (19%), and 13 normal (8%). Consultants performed 53 cases (20%), including 25 inflamed (47%), 16 perforated (30%), and 3 normal (6%). CTs performed 40 cases (15%), including 29 inflamed (73%), 4 perforated (10%), and 6 normal (15%). Median pre-operative CRP was 83 for consultant-led cases, 27 for registrar-led cases, and 31 for CT-led cases. Average operative times for inflamed appendicectomies were 85 minutes for CTs, 78 minutes for registrars, and 83 minutes for consultants. Conclusions Registrars performed the majority of appendicectomies, highlighting significant training opportunities at this level. CT involvement was less frequent but demonstrated similar operative times, suggesting potential for increased participation. Pre-operative CRP levels varied by surgeon grade, possibly reflecting case complexity. This study underscores the importance of structured training and equitable case allocation to ensure skill development for all trainee grades.

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