Introduction: Several previous publications have failed to demonstrate statistically significant differences in postsurgical outcomes between resident participation versus attending only in intraoperative cases. The purpose of this study is to correlate different postgraduate years (PGY) in the neurosurgical specialty with postoperative outcomes.
Methods: NSQIP was queried for adult neurosurgical cases, designated into the four major subspecialties: spine, open-vascular, cranial-other and functional. Utilizing data from 2005-2014, 30-day postoperative outcomes were compared among junior residents [PGY 1 – PGY 3], mid-level residents [PGY 4 + PGY 5], senior residents [PGY 6 + PGY 7], and attending-only. The burden of preoperative comorbidities was analyzed with Frailty Index and American Society of Anesthesiologists (ASA) Class. Multivariable regressions explored three outcomes: any wound complication (surgical site infection [superficial, deep, or organ-space] and/or wound dehiscence), Clavien-Dindo Class 4 (life-threatening complication), and death.
Results: Compared to junior resident (n=3785), mid-level resident (n=2810), and senior resident (n=3746) cases, the attending-only cases (n=12517) experienced statistically significantly lower percentages of wound complications (p<0.001), Clavien-Dindo Class 4 (p<0.001), and death (p<0.001). However, following a multivariable regression, only the junior resident category, as compared to attending-only, incurred statistically significantly higher incidences of life-threatening complications (OR 1.41, p=0.007). Moreover, ASA Class, Frailty Index, operative time, and/or emergency status consistently produced stronger prognostic factors of all three outcome measures. Lastly, compared to spinal cases, cranial cases predicted higher life-threatening complications (OR 2.47, p<0.001) and death (OR 2.17, p<0.001), and open-vascular cases predicted lower wound complications (OR 0.31, p=0.008) and higher life-threatening complications (OR 2.45, p=0.002).
Conclusions: Although cases were more technically challenging, patients in the senior resident cohort exhibited a higher comorbidity burden preoperatively. Thus, the increased odds of life-threatening outcomes among the junior level residents in less complex cases underscore the risks of operating on healthier patients, who are susceptible to a wider range of new-onset complications.
Patient Care: This research study highlights the safety of operative assistants with residents a different levels in postgraduate year (PGY) training.
Learning Objectives: By the conclusion of this session, participants should
1) Identify which group of residents have an increased risk of life-threatening complications postoperatively? And why?
2) Describe which subspecialties predicted wound disruption, life-threatening complications, and death