Impact of Resident Participation During Surgery on Neurosurgical Outcomes: A Meta-Analysis

Shivani Baisiwala, Nathan A. Shlobin, Michael B. Cloney, Nader S. Dahdaleh*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

Abstract

Background: There has been much attention recently on whether the involvement of neurosurgical residents during surgery impacts patient outcomes. Our goal was to perform a meta-analysis of all existing studies in order to determine the true effect of resident involvement. Methods: We performed a systematic review and identified studies that compared resident involvement during surgery to attending neurosurgeons alone. Event rates and adjusted odds ratios were collected and pooled to generate estimates. Results: Eleven studies were identified, of which 9 reported adjusted odds ratios. Meta-analysis showed that there were no significant differences in patient baseline characteristics (age, gender, the majority of medical comorbidities). Analysis of operative variables showed increases in a number of complications. However, adjustment of odds ratios for confounders eliminated most of these effects but continued to show a mild increase in overall complications with an odds ratio of 1.14 (P = 0.02). Notably, for both adjusted and unadjusted estimates, no significant differences were seen in 30-day mortality. Conclusions: We found that, when adjusted for comorbidities, complexity, and procedure type, there was no difference in outcomes in terms of surgical complications, reoperation, length of stay more than 5 days, and mortality. While these results suggest that our apprenticeship teaching model is safe for developing independent physicians, using new educational modalities such as simulation and resident-directed labs may be useful to attenuate potential patient complications in higher-risk procedures and in patients with comorbidities.

Original languageEnglish (US)
Pages (from-to)1-12
Number of pages12
JournalWorld neurosurgery
Volume142
DOIs
StatePublished - Oct 2020

Keywords

  • Meta-analysis
  • Neurosurgery
  • Neurosurgical
  • Outcomes
  • Patient safety
  • Residents
  • Systematic review

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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