Impact of resident involvement in neurosurgery: an analysis of 8748 patients from the 2011 American College of Surgeons National Surgical Quality Improvement Program database

Abstract

OBJECT This study evaluates the impact of resident presence in the operating room on postoperative outcomes in neurosurgery. METHODS The authors retrospectively reviewed the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) and identified all cases treated in a neurosurgery service in 2011. Propensity scoring analysis and multiple logistic regression models were used to reduce patient bias and to assess independent effect of resident involvement. RESULTS Of the 8748 neurosurgery cases identified, residents were present in 4529 cases. Residents were more likely to be involved in complex procedures with longer operative duration. The multivariate analysis found that resident involvement was not a statistically significant factor for overall complications (OR 1.116, 95% CI 0.961–1.297), surgical complications (OR 1.132, 95% CI 0.825–1.554), medical complications (OR 1.146, 95% CI 0.979–1.343), reoperation (OR 1.250, 95% CI 0.984–1.589), mortality (OR 1.164, 95% CI 0.780–1.737), or unplanned readmission (OR 1.148, 95% CI 0.946–1.393). CONCLUSIONS In this multicenter study, the authors demonstrated that resident involvement in the operating room was not a significant factor for postoperative complications in neurosurgery service. This analysis also showed that much of the observed difference in postoperative complication rates was attributable to other confounding factors. This is a quality indicator for resident trainees and current medical education. Maintaining high standards in postgraduate training is imperative in enhancing patient care and reducing postoperative complications.

Impact of Resident Participation on Outcomes After Single-Level Anterior Cervical Diskectomy and Fusion

“…3,4 Numerous studies were conducted to elucidate the relationship between resident involvement and postoperative complications with conflicting results. [5][6][7][8][9][10][11][12] Several studies have demonstrated that resident involvement was not a risk factor for increased complications in neurosurgery, orthopedic surgery, or urology. [5][6][7][8] Meanwhile, other studies have shown increased operative durations and post-operative complications when residents were involved in surgery.…”

“…[5][6][7][8][9][10][11][12] Several studies have demonstrated that resident involvement was not a risk factor for increased complications in neurosurgery, orthopedic surgery, or urology. [5][6][7][8] Meanwhile, other studies have shown increased operative durations and post-operative complications when residents were involved in surgery. [9][10][11][12] In ACDF, resident participation in the operating room occurs early on and continues through their senior years of training.…”

Risk factors for post-operative respiratory failure among 94,621 neurosurgical patients from 2006 to 2013: a NSQIP analysis

“…In the absence of traditional high-level medical evidence (i.e., randomized controlled trials) for outcomes after many neurosurgical procedures, analysis of large prospective registries is becoming increasingly important in determining the exact risks and benefits of surgical intervention [16,18,20,22].…”

“…The data are collected by trained surgical reviewers employed at each participating site. The NSQIP dataset has been previously validated [18], and has been used to evaluate outcomes for a variety of neurosurgical procedures [15,16,[18][19][20][21][22][23][24][25][26].…”

“…In this study, the American College of Surgeons (ACS) National Surgical Quality Improvement (NSQIP) database, a nationwide, standardized, risk-adjusted database that collects information on 30-day morbidity for patients undergoing a wide range of surgical procedures, was used to identify risk factors for PRF after neurosurgical procedures [11][12][13][14][15][16][17]. Thorough analysis of the NSQIP data and identification of risk factors can help guide clinical decision-making, decrease length of stay, improve patient outcomes, and lower costs.…”