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

Abstract

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. 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. 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. 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.