Introduction: Neurosurgery residency training continues to evolve rapidly. Studies in other surgical fields suggest complications, operative time (op-time), estimated blood loss (EBL), and cost may be associated with level of resident training, but this has not been studied in neurosurgery. We sought to evaluate the relationship between resident experience and surgical outcome for anterior cervical fusions, a commonly performed procedure in neurosurgery residency. We studied the association between resident training level and op-time, EBL, and inpatient complications, hypothesizing that op-time and EBL would be inversely proportional to the level of resident training.
Methods: We performed a secondary analysis of prospectively collected data on op-time, EBL, and complications among patients enrolled in a health outcomes study of cervical spine surgery. All patients underwent elective anterior cervical fusion surgery for degenerative indications at a single academic institution. Resident/fellow level of training at the time of surgery was retrospectively collected. Patients with trauma or nondegenerative diagnoses, including central cord syndrome, were excluded. We compared outcomes among residents: junior (PGY 2 to 5) versus senior (PGY 6 to 8, including neurosurgery spine fellows) using Student’s t-test and linear regression.
Results: 115 patients met inclusion criteria. Patient demographics, comorbidities, and diagnosis of myelopathy, and surgical complexity (number of levels treated by decompression, fusion, and/or instrumentation) were similar between senior and junior residents. Op-time was significantly lower for the seniors vs juniors (120 min vs 152 min, p<0.01). EBL was significantly lower for the senior group (104 cc vs 137 cc, p=0.04 [log transformation]). Complications were similar between junior and senior residents (p=0.31).
Conclusions: Resident level of training was inversely associated with op-time and EBL. However, complications were not significantly different between juniors and seniors. Although longer op-time may be associated with increased cost, patient outcomes did not appear to be adversely affected by resident training level.
Patient Care: This research shows that level of resident training is directly proportional to shorter operative times and blood loss; however, given lack of published data and significant economic implications, future investigation is warranted. It emphasizes that resident training does not alter perioperative complication rates and is likely "safe" from a patient care perspective. It also outlines some aspects of current Neurosurgical residency training and its relationship to patient outcomes.
Learning Objectives: 1. Level of residency training is inversely associated with operative times and blood loss.
2. Patient outcome, as measured by perioperative complications, is not significantly different between junior and senior residents.