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DOI: 10.1055/s-0034-1383767
Is Surgical Resident Education Safe? Cohort Study on Complication Rates and Postoperative Outcome after Anterior Cervical Discectomy
Aim: Previously, we were able to demonstrate that the early introduction of residents to microscopic lumbar disc surgery within a structured education program did neither harm the patient nor led to worse 1-year health-related quality of life and pain outcomes, compared with those of experienced board-certified faculty neurosurgeons (BCFN).1 It was our aim to analyze whether surgical education of residents was also safe for anterior cervical discectomy with or without fusion (ACD(F)).
Methods: Retrospective single-center cohort study on patients with full available data undergoing ACD(F)-surgery at the neurosurgical department of the Kantonsspital St. Gallen between 01/2011 - 08/2013. Study groups were built according to the status of the primary surgeon of the index surgery being either a) resident or b) BCFN.
Results: 203 patients were included, of which 55 (27.1%) were resident- and 148 (72.9%) were BCFN cases. Besides patients from the BCFN group being slightly older (mean 52.2 versus 56.5 years; p = 0.045), there were no differences in baseline- and surgery-related parameters. Intraoperative complications were equally low (1.81% (residents) versus 1.35% (BCFN); p = 1.00), wrong level exposure was documented in 5.4% and 3.4% of the procedures (p = 0.685). Resident surgeries were significantly longer (mean 130 versus 93 minute; p < 0.0001) and associated with higher estimated blood loss (80.1 versus 57.6 ml; p = 0.0019). Radiological outcome was regular in 100% of patients from both groups. Inpatient complication rates were similar and the length of hospitalization was virtually equal (4.8 versus 4.9 days; p = 0.932). After 4 weeks, 90.9% and 93.2% of patients had profited from the operation (p = 0.764), while more patients in the resident group reported persistent dysphagia at this time (25.5% versus 10.8%; p = 0.013). After a mean of 3 months postoperative, 85.5% and 89.2% of patients had profited from the operation (p = 0.626). 7.3% and 4.1% of patients had to undergo reoperation until the final follow-up for various reasons (mostly adjacent segment disease; p = 0.464).
Conclusion: Our results indicate that while resident surgeries take longer and are associated with slightly higher blood loss, complication rates and postoperative outcomes after ACD(F)-surgery are not worse when performed by residents-in-training and under careful supervision by experienced BCFN.
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