Analysis of Patient Safety and Outcomes of Live Case Demonstrations in Endoscopic Skull Base Surgery

Background Incorporation of live surgery demonstrations in educational programs has been considered a valuable teaching method but continues to be controversial with little data on patient outcomes. There have been no studies regarding televised surgery in the fields of otolaryngology, neurosurgery, or skull base surgery. The objective of this study was to compare outcomes following live surgery demonstrations of endoscopic skull base surgery with case-matched controls.

Methods Patients who underwent live surgery broadcasts between 2011 and 2017 at a single tertiary care institution were case matched with controls by surgical approach, diagnosis, tumor size within 1 cm, tumor invasiveness, and age within 20 years. Patient outcome measures were compared between groups controlling for covariates.

Results Twenty-four patients undergoing live surgery demonstrations were case matched to 48 patients undergoing routine, nonbroadcasted procedures. Most common diagnoses included pituitary adenoma, meningioma, and clival chordoma. There were no differences in complications including cerebrospinal fluid leak, postoperative infection, seizure, vascular injury, stroke, hypopituitarism, and cranial nerve injury. No difference was seen between groups in gross total tumor resection, length of admission, or blood loss. The length of surgery was significantly shorter in the live surgery group (3.2 vs. 5.6 hours, p < 0.003) adjusted for tumor size, invasiveness, and type of reconstruction.

Conclusion Live surgery demonstrations of endoscopic skull base surgery procedures do not appear to pose an increased risk of complications or adverse patient outcomes as compared with routine, nontelevised surgery. The length of surgery was significantly shorter in live surgery cases.