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

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.

Keywords: Meta-analysis; Neurosurgery; Neurosurgical; Outcomes; Patient safety; Residents; Systematic review.